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~IIII~'I~!IIII~~III ~ ck# /3~~rs \~lag~.~o <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DIIE: <br />COUN"fY: <br />Dick Casey Concrete, Inc. <br />M-1978-349 <br />Dick Casey Concr Pit <br />December 20, 2000 <br />RECE~VE® <br />DEC 1 1 ?000 <br />Division of Minerals and Cealogy <br />$688.00 (Due on or before your anniversary date) <br />Garfield <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 />operator shall submit [he annual fee, a report and map showing the extent of current disturbances to affected <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 year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual resort man to this form. Please Wore rlrar an <br />adequately labeled Wrap rfrar clearly delineates and includes the above eleurenrs may suffice for n written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />permittee Contact: Shawn Vondette <br />permittee Name: Dick Casey Concrete, Inc. <br />Address: P.O. Box 1815 <br />Rifle, CO 81650 <br />Phone Number: x}709 9~0 - 6~s- ! y6 y <br />Fax Number: 'c~q3-7543 9~0 -bas - /y~6 <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 <br />enclosed. <br />Ignature of Corp rate Officer or Owner <br />~,~ - y- .?Woo <br />Dale <br />ANNUAL FEE and REPORT REQUEST <br />A1:~PERM ITVNASTERDOCUM ENTSUA-AF-01 <br />