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O 1^ <br />D? Z <br />PEPA41TTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and PORT REQUEST <br />6? Ready Mixed Concrete Company <br />?M-1987-049 <br />Bromley Lakes <br />September 29, 2010 <br />RLcE1VEp <br />1/SEP 0 7 2010 <br />Division of Recta <br />Mining & sa etytlon, <br />$$791.00 (Due on or before your anniversary date) <br />Adams <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 man are necessarv, then no new map is reauired. 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 />Perrnittee Contact: <br />Permittee Name: <br />Address <br />Phone Number: <br />Fax Number: <br />Bil mops M <br />eady Mixed Concrete Company _ <br />14585 Old Brighton Rd <br />Brighton, CO 80601 <br />(303) 659-0630 <br />(303) 659-7353 <br />If you have additional comments and/or information that should be <br />below or attach it to this form along with your written report and map. <br />z <br />Signature of Corporate Officer, Owner, or Designee <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />ITte?