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ANNUAL FEE and REPORT REQUEST <br />I f~ <br />PERMITTEE NAME: Bent County Ready Mix RECEIVED <br />PERMIT NO.: M-1995-007 FEB 1 31001 <br />OPERATION NAME: Thomeczek Pit Division of Minerals and Geology <br />ANNNERSARY DATE: February 6, 2002 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Bent <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, FeclamaFton ac~omplishel'toztatz at u ~eceding-yea-neea-d:'sturbartees-that-ate-anticipated-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 vour revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joe H. Thomeczek <br />Permittee Name: Bent County Ready Mix <br />Address: P.O. Box 387 <br /> Las Animas, CO 81054 <br />Phone Number (719) 456-1320 <br />Fax Number: ____ - _--_ -~ T - `- <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach i[ to [his form along with your written report and map. Annual Report instructions are <br />enclosed. <br />L Jo4 D ~~'! A..dnO~C'/L. of.[' ~/ ~t r t <br />Si~dture of Corporate Offifkr or Owner <br />a -6-oa <br />Date <br />M:~PERMnw1ASTERD000MENTSU~-AF-(M <br />