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/,\p JQ T <br />ANNUAL FEE and REPORT REQUEST <br />PERMTITEE NAME: i Southway Construction Company, Inc. ~~~ ~~ ~ ~~~ <br />PERMIT NO.: "~M-1987-012 ~ ~~ ~ Q ~ T007 <br />OPERATION NAME: King Pit ~vMin n c~ rt"c~"''~~fioq <br />9 and SEFety <br />ANNIVERSARY DATE: May 27, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Alamosa <br />According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an_operator <br />_ _ shall submit t_he 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 your revised written annual reuort and annual report man to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />moo. If no new disturbances or reclamation have occurred durinc the urevious year and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Ralph Martinez <br />Permittee Name: Southway Construction Company, Inc. <br />Address: 117 White Pine Dr. <br />Alamosa, CO 81101 <br />Phone Number: <br />(719)589-5103 <br />Fax Number: <br />(719) 589-5522 <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 />Signature of Corporat fficer, Owner, or Designee <br />J~'/- <br />Date <br />