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ANNUAL FEE and PORT QUEST <br />PERMITTEE NAME: Bent County Ready Mix <br />PERMIT NO.: A-1995-007 <br />OPERATION NAME: Thomeczek Pit <br />ANNIVERSARY DATE: February 6, 2009 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Bent <br />Wivkjo'; os .- ;:;!-:f:a'ion' <br />Wining pm6 safeiy <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 />lan , rec amation accomplished to date and curing the preceding year, he-w- istu"rbances that are anticip"wed fo - --` <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 vour revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />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: Joe H. Thomeczek <br />Permittee Name: Bent County Ready Mix <br />Address: P.O. Box 387 <br />Las Animas, CO 81054 - <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 instructions are enclosed. <br />Sig ure of Corporate Officer Owner <br />3 - -09 <br />Date <br />,,%m ti?w * ww di4? &rL, <br />n:rto9,^_ e ;..g FL?OA.