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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ ~ 1 ' <br />ANNiiAi. FF.F. and REPORT RF.Oi1F.ST <br />Do/rn Ready-Mix Corp <br />(~3-1974-092 <br />Barlow Pit <br />October 31, 2005 <br />M <br />R~- ~a~°^~ED <br />~'s <br />Division of Minerals and Ga010gy <br />$688.00 (Due on ar before your anniversary date) <br />Morgan <br />According to C:R.S. 34-32.5=116 or C.R-S. 34=32-I 1G, eaeh_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 ynnr revised written annnai re~nnrt and annnal re~nrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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: Doug Dowling <br />Permittee Name: Dom 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 /> <br />