2006-10-20_REPORT - M1980201

• Permit No: M1980201
• IBM Index Class Name: Report
• Doc Date: 10/20/2006
• Doc Name: Annual Fee/Report/Map
• From: Mathias Concrete, Inc.
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
t/ ANNUAL FEE and REPORT REQUEST
i//Mathias Concrete, Inc.
/ M-1980-201
O'Bannon Pit
October 23, 2006
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RECEIelED
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" Division of Reclamation,
Mining and Safety
$688.00 (Due on or before your anniversary date)
Rio Grande
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
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
-~ -reclamation-accomplished-to-date and-during-the-preecding year,-new-disturbances that-are-anticipated-[o occur'
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the arevious year and no new chances to
the previous year's map are necessary. then no new map is required, provided that the Operator shall state
this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the
above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Thomas G. Mathias /
v
Permittee Name:
Address:
Phone Number:
Fax Number:
Mathias Concrete, Inc.
1500 N. Farm Rd.
P.O. Box 266
Monte Vista, CO 81144
[phone]
[phone]

If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form a1Ppg with your written report and map. Annual Report instructions are enclosed.
Signature of Corporate Officer, Owyi'er, or Designee