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M <br />h h~ <br />;/ ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br />PERM[TTEE NAME: //Bent County Ready Mix <br />PERMIT NO.: ~/ bI-1995-007 ~ MAR 14 2006 <br />OPERATION NAME: Thomeczek Pit ~/ Division ~f Minerals and Gealo'y <br />ANNIVERSARY DATE: February 6, 2006 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Bent <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 />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the 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 annual report and anneal report map to this form. Please note brat arr <br />ndeguately 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: Joe H. Thomeczek <br />PerTrrittee Name: Bent County Ready Mix <br />Address: 1'. O. Box 387 <br />Las Animas, CO 51054 <br />Phone Number: (719) 456-1320 <br />Fax Number: <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 instnrctions are enclosed. <br />Si ahire of Corporate rcer or Owner <br />3 3 <br />Date <br />~~ ~,.t ,; <br />