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ANN ff E E and REPORT REQUEST <br />PERMITTEE NAME: Vt Ready Mix Concrete, Inc. <br />PERMIT NO.: 1974 -069 <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <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- upeeming year - reclamation -that will be performed_dnring_the .coming year thh dates for the be _ ing Wing <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 year's map are necessary, then no new map 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: Steve Fancher <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Loveland Ready Mix Concrete, Inc. <br />P.O. Box 299 <br />1811 W. 12th St. <br />Loveland, CO 80539 <br />(970) 667 -2680 <br />(970) 667-0036 <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 forntalong with your written report and map. Annual Report instructions are enclosed. <br />ignature of Corporate Officer, Owner, or Designee <br />Date <br />Larimer Pit <br />July 31, 2011 <br />$$791.00 (Due on or before your anniversary date) <br />Larimer <br />JUL 2 7 2011 <br />ecS £ <br />Division of Reclamation, <br />!Mining and Safety <br />