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ANNUAL FEE and REPORT REQUEST <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Southwest Ready-Mix, Inc. <br />M-1983-175 <br />Alamosa Pit No. 2 <br />November 25, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Alamosa <br />RECEsVE p <br />NOV 2) ?002 <br />O~wslan of Minerals and Geology <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 [o affected land. <br />"`-reclamation accomplished fo 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 [he beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual reuort and annual reuort mao 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 Con[act Kris DeGolyer <br />Permittee Name: Southwest Ready-Mix, Inc. <br />Address: 117 White Pine Dr. <br />Alamosa, CO 8110] <br />Phone Number: (719) 589-5103 <br />Fax Numbec (719) 589-5522 <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 />.,~~ ~.~ <br />Signature of Corpo~r to Officer, Ow er, or Designee <br />//1 Zz~n~. <br />Date <br />M: WERMITVv1ASTERDOCUMENTSV\M1-AROI <br />