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<br /> <br />RECEI!/ED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Fremont Paving &Redi Mix, Inc. <br />M-2000-151 <br />McCumber Hill Pit <br />April 18, 2004 <br />$b88.00 (Due on or before your anniversary date) <br />Fremont <br />APR 16 2004 <br />Division ai Minerals & Geology <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 far the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ymrr revised written anneal report and anmial report mat to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the 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: Denise Gonzales <br />Permittee Name: Fremont Paving &Redi Mix, Inc. <br />Address: P. O. Box 841 <br />Canon City, CO 81215-0841 <br />Phone Number: (719) 275-3264 <br />Fax Number: (719) 275-8897 <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 />(f~~C G~~T--~ <br />Signature o orporate Officer, Owner, or Designee <br />s~-15- vim/ <br />Date <br />