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Q-M,~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />t/ ANNT1Ai, FF.F, and RF.PnRT RF.~iTF.CT <br />~ Rocky Mountain Materials & Asphalt, Inc. <br />'/M-1992-016 <br />Penrose Ranch's <br />June 24, 2006 <br />C~'se~ <br />'/ JUL 171006 <br />DivisionofMinerel$andCeoingY <br />$688.00 (Due on or before your anniversary date) <br />Fremont <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 ym~r revised written anneal rennrt and anneal re~nrt m,~p to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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 />Phone Number: <br />Fax Number: <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 />l`y <br />Signature of Corporate Officer, weer, or Designee <br />Colorado Springs, CO 80906 <br />(719).473-3100 <br />(719) 473-3109 <br />Date <br />