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ct ' n <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />(r 1 <br />ANNU~ FEE and REPORT REQUEST <br />/- Star Ready Mix <br />.~-I977-szz <br />Herman Feit Pit <br />March 23, 2007 <br />MaR 2 s 200 <br />q}vlsion of Reclamation, <br />Mining and Safety <br />$$688.00 (Due on or before your anniversary date) <br />Weld <br />~~ <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 for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new chances to <br />the previous year's map are necessary. then no new man is required. provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Al Lunbery <br />Permittee Name: <br />Address: <br />Star Ready Mix <br />3800 O St. <br />Greeley, CO 80631 <br />Phone Number: (970) 392-1333 <br />Fax Number: (970) 392-1999 <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 fo/rm along with your written report and map. Annual Report instructions are enclosed. <br />Signature o orporate Offic ,Owner, or Designee <br />-aa - o ~ <br />Date <br />