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<br />~O ~~, <br />~~ <br />RECEIVE <br />MAR 16 2004 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Mouutain Park Concrete, Inc. <br />M-1998-034 <br />Parshal Pit <br />March 17, 2004 <br />$281.00 (Due on or before your anniversary date) <br />Grand <br />Division of Minvrplg ~ Qg®l~f <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 cun•ent 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 year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ymrr revised written anneal re,Pnrt and anneal re~nnrt ma~tn this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: M. Joe Docheff, III <br />Permittee Name: Mountain Park Concrete, Inc. <br />Address: P. O. Box 856 <br />Granby, CO 80446 <br />Phone Number: (970) 887-3444 <br />Fax Number: (970) 725-3444 <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 />~ gnature o Corpora f ~cer, weer, or Designee <br />L3 i~ vy <br />Date <br />