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5 0 <br />t <br />ANNiJ L FEE and REPORT REQUEST <br />RECEIVED <br />PERMITTEE NAME: ('Loveland Ready Mix Concrete, Inc. <br />PERMIT NO.: bA-1974-069 -?IJUL 14 2009 <br />OPERATION NAME: Larimer Pit Division of Reclamation, <br />? Mining and Safety <br />ANNIVERSARY DATE: July 31, 2009 <br />ANNUAL FEE DUE: $$791.00 (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 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 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 during the previous year and no new changes 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 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: Steve Fancher <br />Permittee Name: Loveland Ready Mix Concrete, Inc. <br />Address: P.O. Box 299 <br />1811 W. 12th St. <br />Loveland, CO 80539 <br />Phone Number: (970) 667-2680 <br />Fax Number: (970) 667-0036 <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 fo along with your written report and map. Annual Report instructions are enclosed. <br />A <br />/ 7-WI <br />Si atur Co orate Officer, Owner, or Designee <br />Date