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<br />~ ~ III IIIIIIIIIIIII III <br /> <br />ANNUAL REPORT <br />PERMITTEE NAME: Mathias Concrete Inc <br />PERMIT NO.: M-80-201 <br />OPERATION NAME: O'Bannon Pit* <br />ANNIVERSARY DATE: October 23, 1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 <br />COUNTY: Rio Grande <br />~~ <br />~~ . <br />~G~~J~~ <br />~ ~ ~~a <br />J~ r ~ 7. ~~'~G~~yaY <br />According to C.R.S. 34-32-116(3)(a), 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 <br />[o affected land,-reclamation accomplished [o date and during the preceding year, new - <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for [he beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this <br />annual report. Please note that an ndequntely labeled map that clearly delineates and <br />includes die above elements may suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: ~ ~Gr'~+~4s Company: )~1/1 G ~ ra .9,., veer. ~.-~• <br />Address:~~(o ~ ~,6~ Phone No.: (7/~ ~°,~ -3 23i <br />~~w-I-e t~ ~'c-f~; C°t~ -~// ~~ Fax No.:~ /7 G) ~'~.2 ~ 3 7 ~~ <br />L` there are additional comments and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach it to this report form along with your map and/or <br />written report. <br />Signature of Corporate Officer, or Owner Date <br />/NSTRUCTlONS ON BACK <br />