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- T <br />O1G <br />M*C- <br />:? Pr <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Loveland Ready Mix Concrete, Inc. <br />PERMIT NO.: 'M-2001-022 <br />OPERATION NAME: Green/Croissant Property Sand and Gravel Mine <br />ANNIVERSARY DATE: January 16, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <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 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 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 <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: Steve Fher <br />o <br />Permittee Name: L <br />veland Ready Mix Concrete, Inc. <br />Address: P.O. Box 299 <br />Loveland, CO 80539 <br />Phone Number: (970) 667-2680 <br />Fax Number: (970) 667-0036 <br />If you have additional comments and/or information that should be pro vided to the Division, please provide it <br />below or attach ' o this form along with your written report and map. Annual Report instructions are enclosed. <br />r <br />Sig <br />t f of orporate Officer <br />Owner <br />or Desi <br />nee RECp1`1iF® <br />? <br />, <br />, <br />g <br />u 2 ?/- 00 y SAN 14 2009 <br />Date Division of Reclamation, <br />i` M <br /> ining and Safety