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<br />~co <br /> ANNTIAT. FFF. and REPORT RF.O TIF.ST <br />RECEIIlEp <br />PERMITTEE NAME: Mathias Concrete, Inc. <br />PERMIT NO.: M-1977-140 JAN 1 7 20pg <br />OPERATION NAME: N Farm Rd Pit No 1 Division et Mineral <br /> s and DeoloBY <br />ANNIVERSARY DATE: January 15, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Rio Grande <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 yea% new disturbances that are anticipated to occur - <br />during the upcoming year, reclamation that 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 ynnr revised written annual rennrt and annual re~nrt m.~n to this form. please note that an <br />adequately labeled map that clearly delineates mid includes the 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: Thomas G. Mathias <br />Permittee Name: Mathias Concrete, Inc. <br />Address: 1500 N. Farm Rd. <br />P.O. Box 266 <br />Monte Vista, CO 81144 <br /> <br /> <br />Phone Number: (719) 852-3732 <br />Fax Number: (719) 852-3759_ <br />Y <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 />Signature of Corporate O ficer, Owner, or Desi ee <br />/- /~- ~. <br />Data <br />