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,- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~% <br />~M.A. Concrete Construction, Inc. <br />M 2004-020 <br />Cole Gravel Pit <br />November 15, 2005 <br />~r ~ <br />RECEIVED <br />OCT 1 31005 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Mesa <br /> <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 />- - ]and,-reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during [he 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 your revised written anmral re~nrt and anmral rennrt 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 <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Martin Azcarraga <br />Permittee Name: M.A. Concrete Construction, Inc. <br />Address: 2323 River Rd <br />Grand Junction, CO 81505 <br />Phone Number: (970) 243-3221 <br />Fax Number: (9?0) 243-9757 <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 <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:~PERMITNIASTERD000MENTSUI-AF-09 <br />