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DEC-i3-2007 11:57AM FROM-DIV RECLAMATION MINING & SAFETY 3038328102 <br />~F ~' R~~ <br />ANIWAL F1F:R and REP RT RE XJ>F:Sr <br />PERMITTEE NAME: Dick Casey Concrete Inc <br />PERMIT NO.: M-1978-349 >/ <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />Dick Casey Concrete Pit <br />December 20, 2007 <br />T-AA8 P.D02/003 F-425 <br /> <br />ANNUAL I'EE DUE: $791.00 (Dae on or before your anniversary date) <br />COUNTY: GarPeld <br />DEC 1 ~' 2007 <br />Division ®¢ ~ec~ama~t+on, <br />IUiining and \afety II// <br />According to G.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the ptxtnit, an operator <br />shall submit the annual fee, a report and map showing the extent of current 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 vour revised written annual resort and annual report man to this form. The Annnal Report <br />& Fee requiremeat is not met antil we have received the following components: fee re o and associated <br />ID9n. If no new disturbances o clamation have occurred during the previous veer and no new changes to <br />the previous year's ap are pecessarv. then no new map is required, provided that the Operator shall state <br />this in the,,®gnaal Report. Pleasr note drat an adequately labeled trap that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact infonmation. Please verify and make any necessary <br />changes: <br />PetYnittee Contact; Shawn Vondette <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Dick Casey Concrete the _ <br />P.O. Box 1815 <br />Rifle, CO 81650 <br />(970) 625-0746 <br />(974) 625-1486 <br />If you have additional Comm ,~d/or ' formation that should be provided to the Division, please provide it <br />below or a it to this fo ong with our written report and map. Annual Report instructions are enclgSed. <br />~ i1/P M <br />afore of Corporate fiver, Owner, or Desi ee <br />~,?c. ly, ~DO'7 <br />Date <br />