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<br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Castle Concrete Company <br />M-1999-004 <br />Table Mountain Quarry <br />June 25, 2003 <br />RECEIVED <br />JUL 2 2 2003 <br />Division ~t Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Fremont <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 />................... ...........Y...,...... ... ....... ...... ........b ..... Y........-...b J....y ...... ....,..............., ...... ..... ......... ... .....,... <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 renurt m~ to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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: B. J. Fuller <br />Permittee Name: Castle Concrete Company <br />Address: 444 E. Costilla St. <br />Colorado Springs, CO 80903 <br />Phone Number: (719) 475-0700 <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 />y ~~`~- <br />Signatu of C rporate Officer, Owner, or Designee <br />Date <br />M:\PERM ITUTASTERDOCUM ENTSUA-AF-01 <br />