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s? <br />PERMITTEE NAME: <br />PERMIT NO.: <br />/ <br />ANNUAL tlE and42E OR REQUEST <br />eady Mixed Concrete Company <br />V M-1987-049 <br /> <br />RECEIVED <br />SEP ? 9 2009 <br />OPERATION NAME: Bromley Lakes Divic,Ili Imation, <br />ANNIVERSARY DATE: September 29, 2009 fV`ininrd and SGlat;/ <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Adams <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 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 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: Bill?.2hmons III <br />Permittee Name: Ready Mixed Concrete Company <br />Address: 14585 Old Brighton Rd <br />Brighton, CO 80601 <br />Phone Number: (303) 659-0630 <br />Fax Number: (303) 659-7353 <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 />, <br />fU1 <br />ignature of Corporate fficer, Owner, or Designee <br />Date