2007-09-12_REPORT - M1974092

• Permit No: M1974092
• IBM Index Class Name: Report
• Doc Date: 9/12/2007
• Doc Name: Annual Fee/Report/Map
• From: Dorn Ready-Mix Corp
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:

_- 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
-_ -~ shall- submit ttte-annu~• 1-fee,-a-report-and-map- showing -the-extent-of-current-disturbances-to-affected -land, - - - -
~reclamafion accompli"sfi3-fo date andau`ring the preceding-year,-new disturbances`that-are-anticipated to occur- -
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual resort and annual resort map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, resort, and associated
maa. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to
the previous year's map are necessary. then no new map is required. provided that the Operator shall state
this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the
above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Doug Dowling
Permittee Name: Dorn Ready-Mix Corp
Address: 19671 Rd R 7
P.O. Box 636
Fort Morgan, CO 80701
Phone Number: [phone]
Fax Number: [phone]
ANNUAL FEE and REPORT RE UEST
Dorn Ready-Mix Corp
M-1974-092
Barlow Pit
October 31, 2007
RECEIVE® /
SEP 1 ~~ ~/
DlVisbn of ReGamatbn,
Mlning and Safety
$$791.00 (Due on or before your anniversary date)
Morgan
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
ice/ i~~
Signa a of Co orate Officer, O er, or Designee
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