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k~S <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />t/ t <br />I,~~RPTt, <br />ANNTIAT. FF.F, and RF.Pt1RT RF,(IiTFST <br />A//sphalt Specialties Co., Inc. <br />/M-2004-009 <br />Turnpike Mining Resource <br />August 4, 2005 <br /> <br />REC~i~~~ <br />~L 2 9 2005 <br />~Givision of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Weld <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 <br />operaFoi sfiall submit-[he annual-fee; a-report-arid-map-showing~trre-ertcni of-currcn~ disturbances to affccted-- <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 ymrr revised written anneal rennrt and anneal rr~ nrt maw to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: ~ I~ob L.4il'rJ <br />Permittee Name: Asphalt Specialties Co., Inc. <br />Address: ., <br />10100 ~alkES ~'t. <br />Henderson, CO 80640 <br />Phone Number: (303) 289-8555 <br />Fax Number: (303) 289-7707 <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 />~~~~~ <br />~~:2 <br />Signature of Corporate Officer, Owner, or Designee <br />7- 77-oS <br />Date <br />M:IPERMIT~MASTERDOCUMENTSN7-AF-04 <br />