2005-12-12_REPORT - M1983176

• Permit No: M1983176
• IBM Index Class Name: Report
• Doc Date: 12/12/2005
• Doc Name: Annual Fee/Report/Map
• From: Asphalt Specialties Co. Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
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ANNTiAi. FF.F. and RF.Pt7RT RF.OiTFST
Asphalt Specialties Co., Inc.
1983-176
Speer Mining Resource
December 9, 2005
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RECEIVED
~EC 1 2 2005
Division of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Adams
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
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished Yo~date and duffing the preceding year, new disturbances that are anficipafed fo occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written anmral rennrt and anneal refit maT to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Rob Laird
Permittee Name: Asphalt Specialties Co., Inc.
Address: 10100 Dallas St.
Henderson, CO 80640
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature o orporate Offcer, Owner, r Designee

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Date