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~J ~ <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Rocky Mountain Materials & Asphalt, Inc. <br />M-1992-016 <br />Penrose Ranch's <br />June 24, 2002 <br />/U~ ~~i~~ <br />o~~, ~~1 <br />~~°'/s <br />era <br />C®o~og <br />$688.00 (Due on or before your anniversary date) <br />Fremont <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-tKe annual fee;-a report anfl map showing the extent of-current distucbarices to affecte8 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. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact infotma[ion. Please verify and make any necessary <br />changes: <br />Permittee Contact: Tom Smith <br />Pernuttee Name: Rocky Mountain Materials & Asphalt, Inc. <br />Address: 1910 Rand Ave. <br />Colorado Springs, CO 80906 <br />Phone Number: (719) 473-3100 <br />Fax Number: (719) 473-3109 <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 />~ T \ <br />Signature of Corporate Offic or ner <br />~'Z \ ~rro L <br />ae <br />M: W ERMI7IMASTERD000 MENTSVN-AF-01 <br />