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1 <br /> • • III IIIIIIIIIIIIIIII <br /> 999 <br /> ANNUAL REPORT <br /> PERMITTEE NAME: Mobile Premix Concrete, Inc. <br /> PERMIT NO.: M-83-067 ' c�E(`,EIVED <br /> OPERATION NAME: Stagecoach Pit , JUL 0 8 1999 <br /> ANNIVERSARY DATE: July 03, 1999 <br /> ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 s;on 01 Minerals&Geology <br /> COUNTY: Adams <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 maRshowing the extent of current disturbances <br /> to affected land, reclamation accomplished to 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 the 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 adequately labeled map that clearly delineates and <br /> includes the 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: Sic- 2e' x,+'^ e- Company: <br /> Address: /S90 br 1244 Ave— Phone No.: (303 ) Gs 7- y33y <br /> .L 2n N t r Cn aN,ze Fax No.: ( 703 ) 6 s7 - V 3�d <br /> If 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 /> 9 <br /> Signature of Corporate Officer, or Owner Date <br /> INSTRUCTIONS ON BACK <br />