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~ 1~ ,~ b,~'llt~ <br />ANNUAL FEE and REPORT REQUEST ~ ~; ~o ~ ~ d ~~, <br />L „t <br />PERMITTEE NAME: ~/ Tony J. Beltramo & Sons, Inc. <br />~ ~~s z s zno~ <br />PERMIT NO.: ~M-1998-101 l~t)ivis?on o" ~r.,~e, ~; ii9Fl, <br />OPERATION NAME: Cesar Pit himmg aa~ ''"`£tY <br />ANNNERSARY DATE: March 29, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Pueblo <br />L~ <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 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 report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the arevious veer and no new chances to <br />the previous year's maa are necessary. then no new man 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: Robert D. Beltramo <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Tony J. Beltramo & Sons, Inc. <br />1541 Stockyard Rd. <br />Pueblo, CO 81001 <br />(719)544-4744 <br />(719)544-0247 <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. Annua] Report instructions are enclosed. <br />~~~ <br />of Corporate Officer, Owner, or <br />C ~-Oco-U~ <br />Date <br />