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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANN AL FEE PdkE r PORT REQUEST <br />4Beady Mixed Concrete Company <br />44-2001-046 <br />Nix Sand & Gravel Mine <br />May 30, 2011 <br />K--"" <br />4AY a 2 2011 <br />i6UIVI;:Iui W:?8ti0tt, <br />N fining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Weld <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 map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee,: fee, report, and associated associated <br />no new changes to <br />map. If no new disturbances or reclamation have occurred no new disturbances or reclamation have occurred during the year and no new changes to <br />the previous year's thepreviousyear's map necessa?,then no new may required,p provided that the Operator shall statenecessa, then no new mayis reguiredprovided that the Operator shall <br /> state <br />this in the Annual in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Bill Timmons <br />Permittee Name: Ready Mixed Concrete Company <br />Address: 4395 Washington St. <br />Denver CO 80216 <br />Phone Number: (303) 659-0630 <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 Corporate Officer, Owner, or Designee <br />7. R Jl <br />Da