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ANNiiAI. FF,F, and RF,PORT RF.(1fiFST <br />~~ <br />PERMITTEE NAME: Rocky Mountain Materials & Asphalt, Inc. ~~~ <br />` P~ <br /> <br />PERMIT NO <br />1992 <br />016 <br />M ~ <br />/U <br />~ <br />.: - <br />- <br />D'`' ?, <br />~ <br />O h's <br />S'an 0f ~i' <br />?~3 <br />ANNI <br />VERSARY DATE: June 24, 2003 Pr`~Saad <br />~ <br /> <br />ANNUAL FEE DUE: <br />$688.00 (Due on or before your anniversary date) a% <br />gY <br />COUNTY: 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 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 ynnr revised written annual report and anm~al rennrt ma~q, to this form- Please note that an <br />adequatefy fabeled map that clearly delineates and includes the 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: Rob Mangone <br />Peitnittee Name: Rocky Mountain Materials & Asphalt, Inc. <br />Address: 1910 Rand Ave. <br />Colorado Springs, CO 80906 <br />Phone Number: (719) 473-3100 <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 />Signatur of Corporate Officer, Owner, or Designee <br />~/~/3 <br />Date <br />M:\PERM INN ASTERDOCUM ENTSUN-AF-01 <br />