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~~;R~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNiiAi, FF.F. and RF.Pt7RT RF.OiTF.ST <br />alt Constructors, Inc. <br />-2001-069 <br />Del Norte West Valley Pit <br />November 5, 2005 <br />/G,~7-CAS <br />$688.00 (Due on or before your anniversary date) <br />Rio Grande <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 />sh~'i~the-etviuel-few;-a-report-and-map showing--the .extent-of-current disturbances-to..a£fected-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 ynnr revised written annnal re~nrt and annnal re~nnrt main, to this form. Please note [hat an <br />adequately labeled map that clearly delineates and includes the above elements may since for a rovritten report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: Todd Stockebrand <br />Permittee Name: Asphalt Constructors, Inc. <br />Address: 7040 Hwy. 160 W. <br />Phone Number: <br />-FaA i.~mber: <br />Alamosa, CO 81101-8519 <br />(719)589-6671 <br />(719}589-0927 <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 />C ~.r7ic. ~~iT~- <br />Signature of orporate Officer, Owner, or Designee <br />/~~ - <br />Date <br />