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~~ ; ~C ~l <br /> ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ick Casey Concrete, Inc. <br />D <br />PERMIT NO.: / <br />~I-1978-349 <br />OPERATION NAME: Dick Casey Concr Pit <br />ANNNERSARY DATE: December 20, 2006 <br />ANNUAL FEE DUE: $$688.00 (Dne on or before your anniversary date) <br />COUNTY: Garfield <br />RECEIVED <br />~ 9 2006 <br />Dlv' 'on o/Reclamation <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-aeeemplished to-date-and-during-the-preceding-year, new-disturbances-that am arrticipated to-occm-- <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 yeaz, if any. <br />Please attach your revised written annual report and annual reooM map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous veer and no new chances to <br />the orevioas year's map are necessary. then no pew map is reaaired. nrovided that the Operator shall state <br />this in the Annual ReoorK. 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: Shawn Vondette <br />Permittee Name: Dick Casey Concrete, Inc. <br />Address: P.O. Box 1815 <br />Rifle, CO 81650 <br />Phone Number: (9_ZO.)_62-5-1-464 ~~7~~ 6.75- 07y6 <br />Fax Number: (970) 625-1486 <br />If you have additional ments and/or information that should be provided to the Division, please provide it <br />below o~ ajtach it to thy~tonrm along with your written report and map. Annual Report instructions are enclosed. <br /> <br />Signature of Corporate Officer, Owner; or Designee <br />~~cc. l~ aaod <br />Date <br />