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PRECEIVED <br /> NOV 0 8 1000 <br /> sse Division of Minerals and Geology <br /> ANNUAL FEE and REPORT REQUEST <br /> PERMITTEE NAME: Asphalt Paving Company <br /> PERMIT NO.: M-1983-089 <br /> OPERATION NAME: Tomah Site <br /> ANNIVERSARY DATE: November 8,2000 <br /> ANNUAL FEE DUE: $688.00(Due on or before your anniversary date) <br /> COUNTY: Douglas <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 /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <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 your revised written annual report and annual report map to this form. Please mote that an <br /> adequately labeled Wrap that clearly delineates and includes the above elements ?nay suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and snake any necessary <br /> changes: <br /> Permittee Contact: lames R. Krattenmaker <br /> Permittee Name: Asphalt Paving Company <br /> Address: 14802 W. 441h Ave. <br /> Golden,CO 80403 <br /> Phone Number: (303) 279-6611 <br /> Fax Number: (303) 279-6216 <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 <br /> enclosed. <br /> Signature of Corporate Officer or Owner <br /> Date <br /> M WERNMWASTERDOCUMENTSW-AF-01 <br />