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~~ ~ ~~ ~' <br />ANNUAL FEE and REPORT REQUEST 4t-/ <br />RECEIVED / <br />PERMITTEE NAME: Pete Lien and Sons, Inc. dba Trans Colorado Concrete ~/ <br />PERMIT NO.: M-1979-192 ~ OCT 0 3 2007 <br />OPERATION NAME: Spotted Burro Pit Division of Reclamation, <br />Mining and Safety <br />ANNIVERSARY DATE: October 14, 2007 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <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 vour revised written annual report and annual resort 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 during the previous year and no new chanties to <br />the previous year's man are necessary, then no new man 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 />~~t~ ~~ <br />Permittee Name: Pete Lien and Sons, Inc. dba Trans Colorado Concrete <br />Address: P.O. Box 440 <br />Rapid City, SD 57709-0440 <br />Phone Number: (605) 342-7224 <br />Fax Number: (605) 394-7246 <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 is form along with your written report and map. Annual Report instructions are enclosed. <br />Signature Co orate Officer, Owner, or Designee <br />/- G~ <br />Date <br />