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!,Q/ y }~1 <br />ANNUAL FE)~ d REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />+'1~I.A. Concrete Construction, Inc. <br />v1~I-2000-032 <br />Monument View Gravel Pit <br />July 14, 2007 <br /> <br />~~~~IV~ p <br />~'/U <br />Di sion ~N 8207 <br />~ining and motion, <br />Safety <br />$$688.00 (Due on or before your anniversary date) <br />Mesa <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-reper~-and-map-showing-tl~extent-e€-current-dishrrbances-tc-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 yeaz, 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 />ma . If no new disturbances or reclamation have occurred during the previous year and no new chanties to <br />the previous year's map are necessary. then no new map 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 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: Martin Azcarraga <br />Permittee Name: M.A. Concrete Construction, Inc. <br />Address: 2323 River Rd. <br />Grand Junction, CO 81505 <br />Phone Number: (970) 243-3221 <br />Fax Number: (970) 243-9757 <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 />t rn~1J~ ~. ~fGS <br />Si ture of Cot rate~wner, or Designee <br />(~-/D-07 <br />Date <br />