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J <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />N~alco Canon City Concrete Div. <br />/M-1977-559 <br />Canon City East Pit <br />February 22,2007 <br />~~~~A@ ~~ <br />o; oF6 2O20p~ ~ <br />;n~ 'n..~,, . <br />n9ano - ~~e;,on <br />SaretY <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 affecte_d_ _ <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated 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 />Please attach your revised written annual report and annual resort mau to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated man. If no new disturbances or reclamation have occurred durinti the previous vear and no <br />new chanties to the previous year's mau are necessary, then no new map is required, urovided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />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 Contact: Randy Symons <br />Permittee Name: Valco Canon City Concrete Div. <br />Address: 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 o~ttach it to this form along with your written report and map. Annual Report instructions are <br />Owner, or Designee <br />Date <br />M:IPERM I7UTASTERIXX: [1MENTSUI-AF-04 <br />