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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />A. Blasi & Son Trucking &Earthmoving, Inc. <br />M-2002-109 <br />Cucharas Pit <br />January 24, 2005 <br />$281.00 (Due on or before your anniversary date) <br />Huerfano <br />~ <br /> <br />n (~ 'r <br />CCU V L L:,uV <br />~icatagl' <br /> <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 suhttlit the annual fed,. amp rR.t_and map=show~g th~~tent o_f_current_diaturbances t~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 ynnr revised written anneal rennrt and anm~al re,Pnrt manrtn this fnrm_ 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: Anthony Blassi <br />Permittee Name: A. Blasi & Son Trucking & Earthmoving, Inc. <br />/~, i`~last ~' Sr~n Tvttt,~;;ra~ ~`+r~, T^~c.. <br />Address: 38043 CR 32.4 <br />Trinidad, CO 81082 <br />- Phone Number: - (-719) 845-8785 - - <br />Fax Number: (719) 845-8786 <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 />~ ~ - ~~_ <br />Signature of orporate Officer, Owner, or Designee <br />t/~105 <br />Date <br />