2005-10-24_REPORT - M1980201

• Permit No: M1980201
• IBM Index Class Name: Report
• Doc Date: 10/24/2005
• Doc Name: Annual Fee/Report/Map
• From: Mathias Concrete Inc.
• To: DMG
• Media Type: D
• Archive: No

~1
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNiiAi, FF'F, and RF,Pt1RT RFni1FCT
~thias Concrete, Inc.
~~~
,R~~ECEIVFC
`OCT 2 4 20D5
y~1980-201 /
~OIYiBion of Minerals and Geology
O'Bannon Pit
October 23, 2005
$688.00 (Due on or before your anniversary date)
Rio Grande
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an operator
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding yeaz, new disturbances that aze anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the yeaz, if any.
PI ac_ eg .attach xRt~r revised written anm~al rr,~nrt and annual reTnrt ma,~ to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Thomas G. Mathias
Permittee Name: Mathias Concrete, Inc.
Address: 1500 N. Farm Rd.
P.O. Box 266
Monte Vista, CO 81144

Phone Number: [phone] r/
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions aze enclosed.
Signature of Corporate OfficPf, Owner, or
J
Dare