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g01C <br />0 <br />.to <br />ANNUAL FEE and REPORT REQUEST A7 <br />PERMITTEE NAME: Star Ready Mix NAN' 2j 2909 <br />PERMIT NO.: M-1977-522 Division of Reclamation, <br />Mining and Safety <br />OPERATION NAME: Herman Feit Pit <br />ANNIVERSARY DATE: March 23, 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 accompCshe?lc -w-date-and-during-the-pr€ceding_year.,_ne-w-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 during the previous year and no new changes to <br />the previous year's may are necessary, then no new may 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: Al Lunbery <br />Permittee Name: Star Ready Mix <br />Address: 3800 O St. <br />Greeley, CO 80631 <br />Phone Number: (970) 392-1333 <br />Fax Number: (970) 392-1999 <br />,017 <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 />ea Ltd <br />Signature of Corporate Officer, wner, or Designee <br />3 ';?3 0 e7 <br />Date