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AF r RFi <br />ANNTiAT, FF.F, and RF.PnRT RF.nTIF,ST <br />~'"~ <br />PERMITTEE NAME: Febbraro Construction Co. <br />PERMIT NO.: -2004-028 1 <br />dMk <br />~UG 12 2005 <br />pjy15100 Of tf 10EPG~~ ' <br />OPERATION NAME: The Broyles Pit <br />ANNIVERSARY DATE: September 21, 2005 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Las Animas <br />~ccorciing.tn.C_R.S_34=325-116.or_C.B.S._3432-t1 r; Parh T~on_the.annivP*~a,y Tarr .,£thP nr,-e,,;r an nperator_ _ <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annnal re~Qrt and annnal rrpnrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joseph Febbraro, Jr. <br />Permittee Name: Febbraro Construction Co. <br />Address: 2010 Santa Fe Trail <br /> Trinidad, CO 81082 <br />Pho~re'NUmbzr" "(~"t'9j84b=7 - -- -- <br />Fax Number: (719) 846-6537 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~s~ ~ ~,cC~ ~~R~ ~~Z.t9 s~t~b ~ ~4~t~ t O~ ooo~•tl ~/adcz.'8c~ <br />.e.~~r`~-~-a ~ 15~~ ooo~-t-~.~1 `?cwt r~ i ~t( o nl <br />Si lure of Corporate ficer, Owner, or Desi ee ~/ <br />S f I -' ©~ L, O G-,r~~~`L Ol'.~~-- BCD /~E~L,f9N/$`170/.I <br />Date ~T / l'- lS U ~ ~~ -_' S'GYtiI <br />~uTv~ ~ <br />rp ,..Y <br />