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Loveland Ready Mix <br />M•1974-069 <br />ANNUAL FEE and REPORT REQUEST <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lorimer Pit <br />July 31,2002 <br />RECEIVED <br />gut Z a aooZ <br />Division of Minerals end Deology <br />$688.00 (Due on or before your anniversary date) <br />Lorimer <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_rrtap_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 yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour 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: George A. Faucher <br />Permittee Name: Loveland Ready Mix <br />Address: P.O. Box 299 <br />1811 W. 12th St. <br />Loveland, CO 80539 <br />Phone Number: (970) 667-2680 <br />Fax Number: {970) 667-0036 <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 />~~ <br />JSigna,./ Corporate Officer or Owner <br /><.Z- O 1i~ <br />Dale <br />M:~PERMITNIASTERDOCUMENTSUI-AF-OI <br />