REP23510

• Permit No: M1974092
• IBM Index Class Name: Report
• Doc Date: 10/16/2003
• Doc Name: Annual Fee/Report Notice
• From: Dorn Ready-Mix Corp
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Dorn Ready-Mix Corp
M-1974-092
Barlow Pit
October 31, 2003
$688.00 (Due on or before your anniversary date)
Morgan
RECEIVE®
OCT 9 62003
OIVISIOg of Minerals and Geology
-_ According.to C.R.S,_34~32.5-L16-or C.R,S~34-32-116, each year, on the anniversary date of the permit, an operator _ _ I
shall submit the annual fee, a report and map showing the extent of current disturbances to affected_land>
reclamation aon a o fished to date and during the preceding year, new disturbances that are anticipated to occur I
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written anneal re~nrt and anneal report m ~n to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Doug Dowling
Permittee Name: Dom Ready-Mix Corp
Address: 19671 Rd R 7
P.O. Box 636
Fort Morgan, CO 80701
Phone Number: [phone]
--Fax Number: - --(970)'867-7443 "-
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signatur of Corp rate Officer, ner, or Designee
,l~/~D 3
Date
M:\PERM nVv1ASTERD000MENTSVv7-AF-01