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?? a K d yvf,,A? S C,n"?' gePtva?c.?y . <br />lR of o <br />tr <br />f <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />AfN nuzj Pce? <br />ANNUAL FEE and REPORT REOUEST <br />r?- <br />Mathias Concrete Inc <br />M-1977-140 <br />N Farm Rd Pit No 1 <br />January 15, 2009 <br />5791.00 (Due on or before your anniversary date) <br />Rio Grande <br />RECEIVED <br />JAN 15 2009 '---- <br />Difton of declamation, <br />AffinkVand Safety <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 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--coniing-year,--the--dates-€or-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 man 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 during 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