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X9V <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />A L FEE and 1t PORT RE VEST <br />' Fremont Paving & Redi-Mix, Inc <br />?VI-1987-131 <br />Penrose Pit <br />June 15, 2011 <br />$$791.00 (Due on or before your anniversary date) <br />Fremont <br />oK <br />bMk <br />RECEIVED <br />JUN 15 20t1 <br />jPM'4"W;WW W* <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: John P. Ary <br />Permittee Name: Fremont Paving & Redi-Mix, Inc <br />Address: 839 MacKenzie Ave <br />Canon City, CO 81212 <br />Phone Number: (719) 275-3264 <br />Fax Number: <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 />Signat of Corporate Officer, Owner, or Designee <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />Date