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Ti~~~„~ r~~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTI': <br />ANNTi4I, FFF, and RF.PnRT RP(IiTF.ST <br />Rocky Mountain Materials & Asphalt, Inc.' <br />~VI-1992-016 <br />Penrose Ranch's <br />June 24, 2005 <br />$688.00 (Due on or before yoar anniversary date) <br />Fremont <br />~i ~~ 2CC5 <br />~_. <br />/~r~l ~ <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 currant disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during fhe 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 attarh }our re~.vised written annual rennrt and anm~al re~nrt mgg to this form. Please nole that an <br />--adeguately-labeled map t&at clearly delineates and includes-lhe-above-elements Wray 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: Rob Mangone <br />Permittee Name: Rocky Mountain Materials & Asphalt, Inc. <br />Address: 1910 Rand Ave. <br />Colorado Springs, CO 80906 <br />Phone Number: (719) 473-3100 <br />Fax Number: (719) 473-3109 <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 enclosed. <br />M~ ~- - - - <br />Signature of Co orate Officer, Owner, or Designee <br />~ ~, t '?~ 2:a o5 <br />Date <br />