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t <br />~~~ ~ l <br />-Y1V~uc; ! ~f <br />~ ; D MG <br />AT~INi}Ai, FF,F, and REPORT RF.OIiFST <br />PERMITTEE NAME: ° Pete Lien and Sons, Inc. dba Trans Colorado Concrete <br />PERMIT NO.: // M-1979-192 <br />OPERATION NAME: Spotted Burro Pit <br />ANNNERSARY DATE: October 14, 2005 <br />ANNUP,L FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: 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 operator <br />---shall submiT-the annual"fee; a report and map-showing tfie extent of-cunent distu?bances to affected-land, <br />reclamation 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 actives operations, and the date active operations ceased for the year, if any. <br />Pl aae ;dtach ym~r revised written annual report and annual report map to this form- Please note that an <br />adequately labeled map that clearly 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 />Permitte~e Contact: Scott Landguth <br />Pennitte~e Name: Pete Lien and Sons, <br />~h~.l1v EriCKSa~ <br />Inc. dba Trans Colorado Concrete <br />Address: P.O. Box 767 <br />Rapid City, SD 57709-0440 <br />Phone t}umber: (605) 342-7224 <br />Fax Number: (605) 394-7246 <br />#~. o. Box yuo <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 />.~Jtit.C..(~(,,,, L <br />Signature of C rporate Officer, Owner, or Designee <br />~ -a~ -05 <br />Date <br />