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{gym ~ ~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />f~~/ <br />AN~NTiAT. FF.F. and RF.P(TRT RF.OTiF.ST <br />" R/ocky Mountain Materials & Asphalt, Inc. <br />/~1~I-1980-193 <br />Sokol Pit <br />October 23, 2005 <br />OCT 2 i 2005 <br />TIISI~u:amt, ~_i ;,.....r,.i:. t_ dial-vj9 <br />$688.00 (Due on or before your anniversary date) <br />EI Paso <br />According to C.R.S. 34-32_.5-I 16 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 ynnr revised written anm~al report and anneal rennrt 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: 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 />/'C~'~` <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />