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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Li k, <br />Ok- <br />Rf r, .?1 <br />A4!917- <br />ANNUAL FEJE a REPORT REQUEST <br />4rans Colorado Concrete a Division of Pete Lien & Sons, Inc. <br />KI-2004-013 <br />St. Barbara Sand and Gravel Mine <br />April 5, 2009 <br />$$791.00 (Due on or before your anniversary date) safoi`y <br />Pueblo <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 upcomin 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-fot the year; -if any: - - - - -- -= ---- - - _ __ <br />Please attach vour 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 during the previous year and no new changes to <br />the previous vear's map are necessarv, 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: Joel Brannan <br />Permittee Name: Trans Colorado Concrete a Division of Pete Lien & Sons, Inc. <br />Address: 3401 Universal Dr. <br />P.O. Box 440 <br />Rapid City, SD 57709 <br />Phone Number: (605) 342-7224 <br />Fax Number: (605) 342-6979 <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 form along with your written report and map. Annual Report instructions are enclosed. <br />l4k .4 //C- ? ?"' - ? I e, - <br />Sign Are of Corporate Officer, Owner, or Designee <br />?/n K <br />79 <br />3/L?/o9 <br />Date