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r- .. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Fremont Paving &Redi-Mix, Inc. <br />M-1980-224 <br />McKenzie Pit <br />October 27, 2003 Division of Minerals and Genlr• <br />$688.00 (Due on or before your anniversary date) <br />Fremont <br />~~C~~6~ <br />OCT 2 4 2003 <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, 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 accomp fished to dates duririg~he preceding year, new disturbance- s tha arm e anhcrpated 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 annnal rennrt and annnal report 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: 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 infortation 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 />Signatun Corporate Officer, Owner, or Designee <br />0' ~3- O <br />Date <br />M iPERMITMASTER DOCUMENTSVN-AF-01 <br />