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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />v ` PP 7 <br />AXX AL FErand REPORT REQUEST <br />?orn Ready Mix Corp. <br />I-1974-092 <br />Barlow Pit <br />October 31, 2010 <br /> <br />Eci <br />?OCT 13 zjw <br />0' iv1s=,e'•soF ucI'nation, <br />$$791.00 (Due on or before your anniversary date) <br />Morgan <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 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 vear's map 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: Doug Dowling <br />Permittee Name: Dorn Ready Mix Corp. <br />Address: 19671 Rd R 7 <br />P.O. Box 636 <br />Fort Morgan, CO 80701 <br />Phone Number: (970) 867-2968 <br />Fax Number: (970) 867-7443 <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 />G/J <br />ignatur of Corporate Officer, wner, or Designee <br />t?l 01 to <br />Date