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III IIIIIIIIIIIII III <br /> ANNUAL FEE and REPORT REOUEST <br /> RECEIVED <br /> PERMITTEE NAME: Valco Canon City Concrete Div. <br /> PERMIT NO.: M-1977-559 FEB 2 6 2001 <br /> OPERATION NAME: Canon City East Pit Division of Minerals and Geology <br /> ANNIVERSARY DATE: February 22,2001 <br /> ANNUAL 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 <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 man to this form. Please note that an <br /> adequately labeled crap that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Randy Symons <br /> Permittee Name: Valco Canon City Concrete Div. <br /> Address: P.O. Box 669 <br /> 730 S. Mactzazie <br /> Canon City, CO 81215-0669 <br /> Phone Number: (719)275-7441 <br /> Fax Number: (719) 275-7470 <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 <br /> enclosed. <br /> Signatu a of C porat Officer or Owner <br /> -46. l� (r <br /> Date <br /> M TER N1ITWASTERDOC U MENTSW-AF-04 <br />