2006-07-31_REPORT - M2004009

• Permit No: M2004009
• IBM Index Class Name: Report
• Doc Date: 7/31/2006
• Doc Name: Annual Fee/Report/Map
• From: Asphalt Specialties Co. Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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('1/I/1W
ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~/Asphalt Specialties Co,, Inc.
1/ M-2004-009
Turnpike Mining Resource
August 4, 2006
F~ECEIVE®
~'!JUL 3 ~ 2006
~'Oivision of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Weld
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 shall submit-the annual-fee, a-report~and'map'showing the extent of-cun•ent-disturbances to affected
land, reclamation accomplished to date and during the preceding yeaz, new disturbances that aze anticipated to
}- ` occur during the upcoming year, reclamation"that will'be performed during the coming yeaz, the dates for the ---
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Pennittee Contact: Rob Laird
Permittee Name: Asphalt Specialties Co., Inc.
Address: 10100 Dallas St.
Henderson, CO 80640
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
~~~ ~~
Signature of Corporate Officer, Owner, or Designee
-26
Date
M:IPEAMIT~MASTERDOCUMENTS~Iv1-AF-04