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<br />~p ~ ~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />M.A. Concrete Construction, Inc. <br />M-2004-020 / <br />Cole Gravel Pit <br />November 15, 2007 <br />RECEIVED <br />OCT 12 2007 ~ <br />Division of Reclamation, ~j <br />Mining and Safety / <br />$$791.00 (Due on or before your anniversary date) <br />Mesa <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 vour revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinti the previous veer and no <br />new chanties to the previous year's map are necessary, then no new map is required. provided that the <br />Operator shall state this in the Anneal Report. Please note that an adequately labeled map that clearly <br />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 />Pennittee Contact: Martin Azcarraga <br />Permittee Name: M.A. Concrete Construction, Inc. <br />Address: 2323 River Rd. <br />Grand Junction, CO 81505 <br />Phone Number: (970) 243-3221 <br />Fax Number: (970) 243-9757 <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 />C5~ e~~ <br />Signature of Cor orate O facer, Owner, or Designee <br />/V -/O -D <br />Date <br />M: WERMITUv1ASTERDOCUMENTSM-AF-04 <br />