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~~ ~ ,~~-- <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.; <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ Trans Colorado Concrete a Division of Pete Lien & Sons, Inc. <br />M-2004-013 <br />St. Barbara Sand and Gravel Mine <br />Apri15, 2007 <br />$$688.00 (Due on or before your anniversary date) <br />Pueblo <br /> <br /> <br />QIVi i i _ _ - ._.~a,)Ofl, <br />t/ Mir:;:,,,,. ~,;u sr,re:ty <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual resort and annual report man to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, renort, and associated <br />map. If no new disturbances or reclamation have occurred durinti the arevious year and no new chanties to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joel Brannan <br />Permittee Name: Trans Colorado Concrete a Division of Pete Lien & Sons, Inc. <br />Address: 3401 Universal Dr. <br />P.O. Box 440 <br />Rapid City, SD 57709 <br />Phone Number: (605) 342-7224 <br />Fax Number: 60 (t0 S - 3 4 2. - (097 9 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Si re of Corporate Officer, Owner, or Designee <br />3/z~/~~ <br />Date <br /> <br />