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f~ ~ III IIIIIIIIIIIII III • <br /> <br />ANNUAL REPORT <br />~-...~ <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550. ~ ~ JAN 18 2000 <br />~~ <br />COUNTY: Rio Grande ,,, ..;nut Minerab & Geology <br />PERMITTEE NAME: Mathias Concrete, Inc. <br />PERMTI' NO.: M-1977-140 <br />OPERATION NAME: N Farm Rd Pit No 1 <br />~' <br />ANNIVERSARY DATE: January 15, 2000 ~,'~ ~~ ECEIVED <br />According to C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the permit, an operator shall <br />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 <br />to occur during the upcoming year, reclamation that will be performed during the coming year, the <br />dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this annual report. Please <br />note that an adequately labeled mnp that clearly delineates and includes the nbove elements mny <br />suffice for a written report. `-gPDU~ Aud /~4-P cvf~p GA e.~ <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />~~ l/Y1 ~~ I'1,~-e~ <br />Contact Name: P <br />Address: <br />Company: ~ 4 /~~r- <br />Phone No.: ( ~~9) ,e~s 5 ~ - .3'T3 z <br />FAX No.: (7~9) X ~~ - ~ ~~9 <br />-.r~eT <br />If there are additional comments and/or information that should be provided to the Division, please <br />provide it on a separate sheet and attach it to this report form along with your map and/or written <br />report. <br />Cn < ten, //~, ~cr~r~ <br />Signature of Corpo ate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />M WERMfIN1A5TERDOCUMEM'SV.1~AF-01 <br />