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~~ <br />~F ~- RPrJ <br />ANNUAL FEE and REPORT REQUEST RECEIVED / <br />PERMITTEE NAME: Mathias Concrete, Inc. ~ OCT 2 2 2007 t/ <br />PERMIT NO.: M-1980-201 l/ Division of Reclamation, <br />OPERATION NAME: O'Bannon Pit Mining and Safety <br />ANNIVERSARY DATE: October 23, 2007 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Rio Graude <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_She ~ctent_of__GUrrenLdismrhan ..c rn afferrrd lanA~_! <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. The Auuual Report <br />& Fee requirement is not met until we have received the following components: fee, resort, and associated <br />map. If no new disturbances or reclamation have occurred during the previous vear and no new chances to <br />the previous year's map are necessary. then no new map is required. provided that the Operator shall state <br />this in the Annual Report. Please note [hat 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: Thomas G. Mathias <br />Permittee Name: <br /> <br />Mathias Concrete, Inc. <br />1500 N. Farm Rd. <br />E.O. Box 266 <br />Monte Vista, CO 81144 <br />(719)852-3732 <br />(719) 852-3759 <br />,, <br />Address: <br />Phone Number: <br />Fax Number: <br /> <br /> <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 />~ , <br />Signature of Corporate Officer Owner, or Designee <br />/D- /~- D7 <br />Date <br />