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-i' <br />~~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ ANNUAL FEE and REPORT REQUEST <br />Asphalt Specialties Co., Inc. <br />M-1983-176 <br />Speer Mining Resource <br />December 9, 2006 <br />DEC 0 'i 2005 <br />Division ui :1_.. ~,:,~..on, <br />t Minix <br />g anc Saiefy <br />$$658.00 (Due on or before your anniversary date) <br />Adams <br />~til~Z <br />~~~~~~ <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />-- reclamation-asc„^~^~~ ~! *e-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 vour revised written annual report and annual report maa to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />maa. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the urevious year's map are necessary, then no new map is required. provided that the Ouerator 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: Rob Laird <br />Pennittee Name: Asphalt Specialties Co., Inc. <br />Address: 10100 Dallas St. <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 enclosed. <br />Signature of Corporate fficer`~O/w~ner, or Desi~ ~ <br />//- 3~ -off <br />Date <br />