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~z~~ <br />/ ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: 1/ /Southwest Ready-Mix, Inc. <br />PERMIT NO.: V M-1983-175 <br />OPERATION NAME: Alamosa Pit No. 2 <br />ANNIVERSARY DATE: November 25, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Alamosa <br />~,ytit,::~~~ r''~~'~ <br />~a ate t <br />~~nov z s 2005 <br />t/Division ci R~riamation, <br />Mining and Safety <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 ana-d'uiiiCg the preceding year, new disturbances Thaf 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 vour revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, reuort, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous year and no new chances 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 Renort. 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: Ralph Martinez <br />Permittee Name: Southwest Ready-Mix, Inc <br />Address: 117 White Pine Dr. <br />Alamosa, CO 81101 <br />Phone Number: (719) 589-5103 <br />Fax Number: (719) 589-5522 <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 />~o~ _~~ <br />Signatu~ ot~ Corporate Of er, Owner, or Designee <br />Date <br />