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ANNUAL FEE and REPORT REQUEST ~~~~! V <br />PERMITTEE NAME: ~L,oveland Ready Mix Concrete, Inc. ~ C d ~® <br />PERMIT NO.: ~I-1974-069 ~ 2''' Z~OJ <br />OPERATION NAME: Larimer Pit ' ~ ^9 and 8a ety on, <br />ANNIVERSARY DATE: July 31, 2007 ¢ ~9f <br />ANNUAL FEE DUE: $$~i88:00 (Due on or before your anniversary date) <br />COUNTY: Larimer <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 c_urrent_disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that aze 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 your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the previous year's map are necessary. then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />1811}YW. 12th St. <br />P.O. Box 299 <br />Loveland, CO 80537 <br />(970) 667-2680 <br />(970)667-0036 <br /> <br />/~JI lcl. l2 ~ ~- <br />8053~J <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or att it to this form along with your writtenQreport and map. Annual Report instructions aze enclosed. <br />c}~ ~~~,~ <br />Sign to o a to Officer, Owner, or Designee <br />~/ 9~a~ <br />Dat~ <br />