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III IIIIIII 9 IIIIII III <br /> 99 <br /> ANNUAL FEE and REPORT REQUEST <br /> RE <br /> PERMITTEE NAME: Transit Mix of Pueblo, Inc. <br /> PERMIT NO.: M-1984-008 A to e CJwt <br /> OPERATION NAME: Barnhart Pit <br /> Division of Minerals and Geology <br /> ANNIVERSARY DATE: May 9,2001 <br /> ANNUAL FEE DUE: $550.00 (Due on or before your anniversary date) <br /> COUNTY: Pueblo <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary dat of the permit, an <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <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 report map to this form. lease note that an <br /> adequately labeled map that clearly delineates and includes the above elements may s> fice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and shake any necessary <br /> changes: <br /> Permittee Contact: Mark Klune <br /> Permittee Name: Transit Mix of Pueblo, Inc. <br /> Address: P.O. Box 857 <br /> Pueblo, CO 81002 <br /> Phone Number: (719) 561-8350 <br /> Fax Number: (719) 566-0231 <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 Rep rt instructions are <br /> enclosed. <br /> iy akk k) V. <br /> Sign ture of Corporate Officer or Owner <br /> o6 <br /> Date <br /> M:TERMITMASTERDOCUNEN-rS\M-AF-01 <br />