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i ~ III IIIIIIIIIIIII III <br />ANNUAL FEE and REPORT REQUEST <br />RECEI VEp <br />PERMITTEE NAME: Transit Mix of Pueblo, Inc. MAR ~ 2 <br />PERMIT NO.: M-1977-573 2001 <br />OPERATION NAME: .Pueblo West Pit ~ivieion of Minerals and GeotOgy <br />ANNIVERSARY DATE: March 22, 2001 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Pueblo <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, rcclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during [he upcoming year, reclamation that will b= performed during [he coming year, the dates for the <br />beginning oC.active operations, and the date active operations ceased for the y.ar; if ary. ~ .. .. <br />Please attach your revised written annual reprirC and annual rep~~e: map to this form. Please nc~e ;bat a:r ' <br />adequately labeled map that clearly delrneares acrd rnchrdes the above elemerrls may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mark Klune <br />Permittee Name: Transit Mix of Pueblo, Inc. <br />Address: P.O. Box 857 <br />Pueblo, CO 81002 <br />Phone Number: (719) 561-8350 <br />Fax Number: (719) 566-0231 <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 <br />enclosed. <br />Signatur of Corporate Officer or Owner ~/ /' ~(IC.~I l~jrr"""'' <br />3- 9-~, oG( <br />Dale <br />M'~PERMIPMASTERDOCU MENTSUI-AF-01 <br />