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<br />RECEIVED <br />PERMITTEE NAME: Central Aggregates, Inc, ppR 2 8 2004 <br />PERMIT NO.: M-1981-006 Dfyb~on of Minerals & GeolopY <br />OPERATION NAME: West Rifle Pit <br />ANNNERSARY DATE: Apri127, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Garfield <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 tthe annual fee, aaieporf 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 ynnr revised wri ten ann gal report and anm.al repnr m P to Chic fnrm_ Please note that an <br />adeguatedy labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Gilbert T. Lee <br />Permittee Name: Central Aggregates, Inc. <br />Address: P.O. Box 1877 <br /> Rifle, CO 81650 <br />Phone Number: (970) 625-3598 <br />Fax Number: (970) 625-4221 <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signatur f Corporate Officer, Owner, or Designee <br />~z.~,~o y <br />Date <br />