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~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNTiAT. FF.F, and REPORT RF,OiiF.RT <br />Central Aggregates, Inc. <br />M-1981-006 <br />West Rifle Pit <br />April 27, 2005 <br />/~ <br />APR 2 0 2C05 <br />.^.ieisicx.•' _ -.sloop <br />$688.00 (Due on or before your anniversary date) <br />Garfield <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 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 ymrr revised written annnal repprt and annual rennrt m T to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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: Gilbert T. Lee <br />Perrnittee Name: Central Aggregates, Inc. <br />Address: P.O. Box 1877 <br />Phone Number: <br />Fax Number: <br />Rifle, CO 81650 <br />(970)625-3598 <br />(970)625-4221 <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 />z <br />Signature of Corporate fficer, Owner, or Designee <br />y~ ~~J <br />Date <br />