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<br />PERMITTEE NAME; <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Bent County Ready Mix <br />M-1995-007 <br />Thomeczek Pit <br />February 6, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Bent <br />RECEIVED <br />JAN 3.9 2003 <br />-~ ,' <br />Division of Minerals and 6anlegy <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 <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annnal report and annnal report main to this form- please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joe H. Thomeczek <br />Permittee Name: Bent County Ready Mix <br />Address: P.O. Box 387 <br />Las Animas, CO 81054 <br />Phone Number: (719) 456-1320 ^ i <br />Fax Number: <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 [his form along with your written report and map. Annua] Report instructions are <br />enclosed. <br />~~ . l <br />~'~ <br />Si lure of Corporate tcer, Owner, or Designee <br />l -3D ~3 <br />Date <br />M:~PERMI7IMASTERD000MENTSVv1-AF-04 <br />