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~ _~~~ <br />A1~AL FEE and REPORT REQUEST <br />PERMITTEE NAME: i Fremont Paving &Redi-Mix, Inc. - ~?FC~ry~D <br />PERMIT NO.: -~ M-1980-224 / ~r'T 2 8 TQQ~ <br />uw+bw,~ „~ rtecia <br />OPERATION NAME: McKenzie Pit Mining end melion <br />safety , <br />ANNIVERSARY DATE: October 27, 2007 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />_. _Accotding.to C.R.S.~4.32.5_ L16_or_C.R.S. 39_32-1 lb, 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 ]and, <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 vour revised written annual resort and annual resort map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, renort, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to <br />the previous year's moo are necessary, then no new man 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: John Paul Ary <br />Permittee Name: Fremont Paving &Redi-Mix, Inc. <br />Address: P.O. Box 1720 <br />Canon City, CO 81215 <br />Phone Number: (719) 275-1280 <br />Fax Number: (719) 275-8897 <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 />S' ature of Corporate Officer, Owner, or Designee <br />Date <br />