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ANNUAL FEE and REPORT REQUEST <br /> <br />PERMITTEE NAME: <br />Asphalt Paving Company .. <br />l~;'";. _ . <br />PERMIT NO.: M-1990-098 "~ J <br />AUG ~ <br />OPERATION NAME: Perry Pit I <br />~iw ° ZQQ) <br />ANNIVERSARY DATE: September 29, 2007 Pnninga~`cta~:~:a,on <br />d S~,-e <br /> <br />ANNUAL FEE DUE: <br />$$791.00 (Due on or before your anniversary date) iY <br />COUNTY: 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 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 foi 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 previous year and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Operator 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 suffice for a written report. <br />Division records indicate the following petrnittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Greg Gerganoff <br />Permittee Name: Asphalt Paving Company <br />Address: 14802 W. 44th Ave. <br />Golden, CO 80403 <br />Phone Number: <br />Fax Number: <br />(303)279-6611 <br />(303)279-6216 <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 Officer, Owner, or Designee <br />Date <br />