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-~e <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Valco Canon City Concrete Div. <br />M-1977-559 <br />Canon City East Pit <br />February 22, 2004 <br />RECFfVFD <br />FEB 2 0 2004 <br />Division of Minerals ~ 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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land; reclamation accomplished to date and' during the preceding year, new disturbances that are anticipates-to-~ <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Ptease attach ynnr revised written annual rennrt ands nn rf man to this form. please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />~.,~..~+~, changes: - - -- --- - .. - - _` <br />`~ Permittee Contact: <br />`'Permittee Name: <br />Address: <br />Randy Symons <br />Valco Canon City Concrete Div. <br />730 S. Mackenzie <br />P. O. Box 669 <br />Canon City, CO 81215-0669 <br />Phone Number: (719) 275-7441 <br />Fax Number: (719) 275-7470 <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 <br />enclosed. <br />Signa re Corp rate icer, Owner, or Designee <br />Lul~lrl o ~ <br />Date <br />M:~PERMITMASTERDOCUMENTSNI-AF-04 <br />