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999 <br /> RECEIVED <br /> ANNUAL FEE and REPORT REOUEST <br /> OCT 0 9 2001 <br /> PERMITTEE NAME: Dorn Ready-Mix Corp Division of Minerals and Geology <br /> PERMIT NO.: M-1974.092 <br /> OPERATION NAME: Barlow Pit <br /> ANNIVERSARY DATE: October 31, 2001 <br /> ANNUAL FEE DUE: $688.00(Due on or before your anniversary date) <br /> COUNTY: Morgan <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 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 your 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 /> Permittee Contact: Doug Dowling <br /> Permittee Name: Dorn Ready-Mix Corp <br /> Address: 19671 Rd. R 7 <br /> P.O. Box 636 <br /> Fort Morgan, CO 80701 <br /> Phone Number: (970) 867-2968 <br /> Fax Number: (970) 867-7443 <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 /> f� •"Z7' <br /> Signs ure of Corporate Of cer or Owner <br /> a 4 4 '?"'e1 <br /> Date <br /> N1:TERMrI MASTERDOCUMENTSO-AF-01 <br />