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•~ • III IIIIIIillllll~ll ck~l7lro i \~68~• oa <br />• RECEIVED <br />DEC 1 1 200 <br />ANNUAL FEE and REPORT REQUEST <br />Division of Minerals and Geology <br />PERMITTEE NAME: Asphalt Constructors, loc. <br />PERMIT NO.: M-1977-053 <br />OPERATION NAME: Lyle Smith Pit <br />ANNIVERSARY DATE: December 23, 2000 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Costilla <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. Please Hole [ha[ nn <br />ndeyun[ely labeled [nap that clearly delineates and includes [he above elements ntnv srrffrce -jor a irri[ren <br />report. <br />Division records indicate the following permittee contact information. Please verif}• and make any necessary <br />changes: <br />Pertnittee Contact: Todd A. Stockebrand <br />Permittee Name: Asphalt Constructors, Inc. <br />Address: P.O. Box 449 <br />Alamosa, CO 81 I OI <br />Phone Number: (719) X89-6671 <br />Fax Number: (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 <br />enclosed. <br />Signature of Corporate Officer or O <br />Dat~ <br />M NERMITUAASTERDOCUMENTS~M-AF-01 <br />