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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REO jU'E~ST <br />Mountain Park Concrete, Inc. <br />M-1998-034 <br />Parshal Pit <br />March 17, 2008 <br />,rF ~~ <br />ez8 ~Q <br />~t ~t~~ah Z0~ <br />~firy~n9~ asa'~a 8 Z/ <br />at~~, on, <br />$$323.00 (Due on or before your anniversary date) <br />Grand <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 your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinE the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: M. Joe Docheff, III <br />Permittee Name: Mountain Park Concrete, Inc. <br />Address: P.O. Box 856 <br />Phone Number: <br />Fax Number: <br />Granby, CO 80446 <br />(970) 887-3444 <br />(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 f m a~ang with your written report and map. Annual Report instructions are enclosed. <br />,_ <br />of Earporate O~~Owner, or Designee <br />Date <br />