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29-JUL-2005 10:05 FROIkColorado Division of Mlinsrals 8 Geology +13038328100 <br />~"` k <br />~~ ~ _ ~, <br />s ~ ~ <br /> <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE_ <br />ANNUAL FEE DUE: <br />COUNTY: <br />~phalt Paving Company ~ r~'V~ " <br />(/ M-1974086 <br />Ralston Quarry <br />July 24, 2005 <br />T-199 P.002/002 f-452 <br />~UG 0 8 2005 <br />V r ~'" V- <br />$550.00 (Doe on or before your anniversary date) <br />Jefferson <br />According to C.R.S. 3432.5-116 or C.R.S. 3432-116, each year, on the anniversary date of the petmit, an <br />operator shall submit the annual fee, a report and map showing the e:ctent of ciurent disturbances to sffeoted - <br />lartd, reclamation accomplished to date and during the preceding year, new disturbances that arc anticipated to <br />occur during the upcoming year, reclamation that will be performed doming the coming year, the dates for tha <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attaph,yonr revised written annnal regprtandannnal renorJ ma= in this form. pje[7se nose th¢t an <br />adequately labeled map that clearly dclineatu oral ir:cludes du: above elemeets rnuy since jar u wri[[ert <br />report. <br />Division records indicate the following petmirtee contact information. Please verify and make any nocessary <br />changes: <br />J'ertnittee Contact: Greg Geryanoff <br />Permitter Name' ,Asphalt Paving Company <br />Address: 14802 W. 44th Ave. <br />Golden, CO 80403 <br />Phone Number: <br />(303)279-6611 <br />Fax Number. (303) 279-6216 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />beiow or attach it to [his form along with your written report and rnap_ Annual Keport instructions are <br />enclosed. <br />~~ <br />Signature of Corporate Officer, Owner, or Designee <br />?-L~ ~~ <br />Date <br />M:~eaMr,~Received Time_,Ju1.29. 10:01 AM <br />