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ANNUAL FEE and REPORT RE UEST <br />PERMITTEE NAME: V?T M.A. Concrete Construction, Inc. ? AUG 2010 <br />PERMIT NO.: ? M-2005-061 Uivia?sn i r i vci ?On, <br />Mining and gaftty <br />OPERATION NAME: 20 Road Gravel Pit <br />ANNIVERSARY DATE: September 1, 2010 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Mesa <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 />_r . -reclamation-accomplished -to- date-and during -the-preceding year-,-new-distur-banes, that-are anticipated to-occur- <br />duringthe 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 vear's man 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: Martin Azcarraga <br />Permittee Name: M.A. Concrete Construction, Inc. <br />Address: 2323 River Road <br />Grand Junction, CO 81505 <br />Phone Number: (970) 243-3221 <br />Fax Number: <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 />Signature of Corpo to Off cer, Owner, or Designee <br />_)C) -10 <br />Date