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<br />ANNUAL REPORT <br />PERMITTEE NAME: Mobile Premix Concrete, Inc. <br />PERMIT NO.: M-1974-004 <br />OPERATION NAME: Specification Aggregates Quarry <br />ANNIVERSARY DATE: February 15, 2000 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 <br />COUNTY: Jefferson <br />According to C.R.S. 34-32-I 16(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. Piertse <br />note that an adequately labeled map dial clearly delineates mid includes the above elem?tus may <br />suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: ER-lL ~~c.1c6rITit36 Company: L/EFkeGv~ <br />Address: 1590 W~ IZ+" /~v5. PhoneNo.: (303 ) 45~--4330 <br />DPotJUFt~, G0 80~-t2 FAX No.: (303) (05-'4?>~_ <br />If there are additional comments and/or information that should be provided to [he 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 />Signature of Corporate Officer, or Owner <br />Date <br />INSTRUCTIONS ON BACK <br />M: W ERM flw7 ASTERDOCUMEM'SN7-AF-01 <br />