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~) <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMTl' NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/Fremont Paving &RediMix, Inc. <br />/M-2000-041 <br />Evans #2 Pit <br />June 21, 2007 <br />~~ <br />R~c~~v~D <br />~UUN 212007 <br />Division of Reclamation, <br />Mining and Safety <br />$$688.00 (Due on or before your anniversary date) <br />Pueblo <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 />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />-Suring the upcoming year,-reclamatioirthat 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 vour 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 />map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances 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 pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: John P. Ary <br />Permittee Name: Fremont Paving &RediMix, Inc. <br />Address: 839 MacKenzie Ave <br />Canon City, CO 81212 <br />Phone Number: (719) 275-3264 <br />Fax Number: <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 />4 <br />'gnature of Corporate Officer, Owner, or Designee <br />(~ -ao - D Z <br />Date <br />