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m AC (-4 K <br />ANNUA FEE andl REPORT REQUEST <br />PERMITTEE NAME: 4 Ioveland Ready Mix Concrete, Inc. <br />PERMIT NO.: A-2001-022 <br />OPERATION NAME: Green/Croissant Property Sand and Gravel Mine <br />ANNIVERSARY DATE: January 16, 2010 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />RrCF-11/F.B <br />JAN 12 2010 <br />Division of Reclamation, <br />Mining & 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 th_e preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the date- 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 map are necessarv, then no new map is reauired, 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 Fancher <br />Permittee Name: Loveland 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 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 />' -//mss <br />Signat e Corporate Officer, Owner, or Designee <br />Date