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:C INC PAGE 05 <br />_, <br />PERMTITEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNTVERSARX DATE: <br />ANNUAL FEE DUE: <br />COUNTY; <br />ANNUAL FEE and REPORT REQUEST <br />Valco Guttuison Concrete Aivision <br />M-1978.287 <br />Vader Fit <br />October S, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Gunnison <br />According to C.R.S. 3432.5-116 or C,R.S. 34-32-i 16, each yeaz, on the anniversary date of the p <br />shall submit the annual fee, a report and map showing the extent of current disturbances <br />reclamation accomplished to date and during fire preceding year, new disturbances that are an <br />during the upcoming year, reclamation that will be performed during the conning year, the dates <br />of active operations, and the date active operations ceased for the yeaz, if any. <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a <br />Division records indicate the following petntittee contact information. Please verify and ma <br />changes: <br />Permittee Contact: Ed Stewart <br />Pcrmiuee Name: Va]co Gunnison Concrete Division <br />Address: P.O. Hox 837 <br />Gunnison, CO B 1230 <br />Phone Number; (970) 641-0951 <br />Fax Number: (970) 641-0954 <br />If you have additional comments and/or information that should be provided to the Division, <br />below or attach it to this form along with your written report and map. Annual Report instructions <br />~~~\ R.~~ <br />Signature of Corporate Officer, Owner, or Designee <br />~~~ <br />Date <br />an operator <br />fected land, <br />fed to occur <br />le beginning <br />note that an <br />rn repon. <br />necessary <br />ie provide it <br />enclosed. <br /> <br />M:NERMIT~MASrERDOCUMEN75U1-AF-(11 <br />