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T <br />?T <br />P?r- -k- U-r <br />ANNUAL FEE and REPORT REQUEST <br />PEIrCMITTEE NAME: J Wyatt Redi-Mix Co <br />PMOAITNO.: / M-1997-039 ,/ AUG 17 201Q <br />OPERATION NAME: Williams/Btinois Gravel Pit Division of Reclamation, <br />and 5afeAy <br />WMG <br />ANNIVERSARY DATE: August 12, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY. Jackson <br />According to C.R.S. 34-32.5-116 or CXS. 3432-116, each year,: on the anniversary date of the permit, an operator <br />Aa^11 submit _ 13t$ a2ri ai feereport _and- map-; showing-the-ex-tent-of _ ourrent-dWurbances tD affectedlandr._ ._- - <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 veased for the year, if any. <br />Please attach your revised written annual report and annual report may 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 su, f `ice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Richard F. Wyatt <br />Permittee Name: Wyatt Redi-Mix Co <br />Address: P.O. Box 1052 <br />Walden, CO 80480, <br />Phone Number: (970) 723-4471 <br />Fax Number: (970) 723-3222 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or ttach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />i afore of Corporate O r, Owner, or Designee <br />Date ?. .-- -----