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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMiT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />Castle Concrete Company <br />M-2001-005 <br />Grisenti Farms Gravel Pit <br />May 23, 2002 <br /> <br />~ ~ ~E~vED <br />t',S:y 2 2 2~ <br />~., ~i M«ere\s aaaQeolagY <br />-ri^i <br />$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 operator <br />shall submit the annual fee, a report and map showing the extent of carrent distcrbances 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 year, 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: Gerald J. Hermans <br />Permittee Name: Castle Concrete Company <br />Address: P.O. Box 1030 <br />Colorado Springs, CO 80901-1030 <br />Phone Number: (719) 475-0700 <br />Fax Number: (719) 475-0226 <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 instmctions are enclosed. <br />Signature f orporate Officer or Owner <br />Date <br />M: W ER M ITN7ASTERDOC UM ENTS VvI-AF-01 <br />