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.- MAY-]0-2002 FRI 09 29 RM <br />FAX N0. <br />iA1Y-OT-07• 00:99 FRO-4~Golorado Divlalon of Yinarala i Ca01ap •18099699697 <br />~j~AL b"£E and REPORT REOIIEST <br />PPRMITTPS NAME: Fratnont Paving & Red1-Mix, Inc. <br />T-647 P.009/008 F-088 <br />PERMIT NO.: M-1995-008 <br />OPERATION NAME: Flartmco Plt <br />ANNYVERSARY DATE: Mqv 13, 2002 <br />ANNUAL FEE DUE: $686.00 (Aue on or before your anniversary date) <br />COUNTY: Fremont <br />P <br />. j02~ <br />E7'' <br />RECEIVED <br />MAY 1 6 20D2 <br />Division of Minerals and Geology <br />According to C.RS. 3432.5-116 or C.RS. 3432.116, each year, on the anniversary dau of the peratit, an operator <br />shall submit the annual fee, a report and map showins the extent of current disturbances to affected land, <br />reclamation accomplished to date and daring the preceding year, new disturbances that are anticipated to ocenr <br />during [he upcoming ycaz, reclamation that will be gerformed during the corning year, the dates for the begianirtg <br />of active operations, and the date active operations ceased for the year, if any, <br />PJsase attach roar revised written annual resort and enn retrort mqn to this form. Please note :hat an <br />adequately labeled map that clearly delineates and includes tha abrwe rlements may st¢fice for a wrirrrn rrport. <br />Division records indicate the following pe[rrtittoe contact lnformation. Please verify apd make any necessary <br />changes: <br />Perminee Contact; Jobe P. Ary <br />Petmittee Names Fremont Paving & Redi-Mix. Tnc. <br />Addres9: P.O. Hox 841 <br />Canon City, CO 81275-0841 <br />Phone Number: {719) 275-3?_64 <br />Fax Number: (719) 275-8697 <br />If you have additional cotranents and/or information that should be provided [o the Division, please provide is <br />below or attach it to this form along with your wriaen report and map. Annual Report instructions are enclosed. <br />[gnanrrc of Caaporate Oi~ccr or Owaet <br />S -/S ©02 <br />Date <br />A7:WRRMITMASTSROONMBM5IM-AP.Ot <br />