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� • III 999 III • <br /> RECEIVED <br /> AUG 0 2 2001 <br /> ANNUAL FEE and REPORT REOUEST <br /> Division of Minerals and Geology <br /> PERMITTEE NAME: Owens Brothers Concrete Company <br /> PERMIT NO.: M-1996-052 <br /> OPERATION NAME: Del Camino Sand and Gravel Mine <br /> ANNIVERSARY DATE: August 4,2001 <br /> ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br /> COUNTY: Weld <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 vour revised written annual report and annual report map to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: (� <br /> Permittee Contact: John Owens <br /> Permittee Name: Owens Brothers Concrete Company <br /> Address: 5550 Sheridan Blvd. <br /> Arvada, CO 80002 <br /> Phone Number: (303)429-5850 <br /> Fax Number: (303) 429-5916 <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 /> Signature of Corporate Officer or Owner <br /> -1 / 23 <br /> Date <br /> M.\PERMITAIASTERD000.%IENTSN1 AF 01 <br />