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d <br />ANAL FL/E and RE? ORT RE E ' <br />OU ST LIX <br />PERMITTEE NAME: ?Valco Canon City Concrete Div. <br />PERMIT NO.: /M-1977-559 <br />OPERATION NAME: Canon City East Pit <br />ANNIVERSARY DATE: February 22, 2011 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />According to C.R.S. 34-32.5-11_6 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit-the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, newaisturbances that are arificipated to --"-- <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Tom Brubaker <br />Permittee Name: Valco Canon City Concrete Div. " <br />Address: 12753 S. Parker Rd. ? <br />Parker, CO 80134 <br />Phone Number: (303) 248-3590 <br />Fax Number: (800) 332-1652 <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 <br />en osed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />--( - ZO It <br />M:IPERMIT?MAS TERDOCUMENTS\N4-AF-04 <br />