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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Owens Brothers Concrete Company <br />M-1996-052 <br />Del Camino Sand and Gravel Mine <br />August 4, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />According to-C_R.S. 34-32.5-116 or C.R.S, 34-32-116. each yearsn the_anniversary date of the permit, an operato <br />shall subitiii the annual-fee, a report and map'sHowing" tfie`extent o cf urrent disturtiances`to affected-land' - - <br />reciatnation accomplished to 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 the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anneal rennrt and anm~al rennrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following perrnittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: William M. Owens <br />Permittee Name: Owens Brothers Concrete Company <br />Address: 5550 Sheridan Blvd. <br />Arvada, CO 80002 <br />Fax Number: (303) 429-5416 <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 Officer, Owner, of Designee <br />7~, ._~,.. L~ 7 nnz <br />Date <br />M:\PERMITMASIERDOCUMENfSM-AF-01 <br />