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<br />.~-i-1-~ <br />ANNTiAT. FF.F. and RF.PnRT RF.OTiF.ST <br />RECEIVED <br />PERMITTEE NAME: Asphalt Constructors, Inc. <br />PERMIT NO.: M-1977-053 NQV Z Z <br />OPERATION NAME: Lyle Smith Pit Division of Minerals and GeoloBY <br />ANNIVERSARY DATE: December 23, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Costilla <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 yea4, reolamafiori that will be performed duriug"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 atta~ynnr reviced written anneal report and anneal re,Pnrt m n 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 information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Todd A. Stockebrand <br />Permittee Name: Asphalt Constructors, Inc. <br />Address: 7040 Hwy. 160 W. <br />~ <br />e <br />P <br />~ <br />x <br />o <br />- ~I <br />f <br />- - <br />, <br />- <br />~ <br />, <br />~ <br />P <br />Alamosa, CO 81101 <br />Phone Number: (719) 589-6671 <br />Fax Number: (719) 589-0927 <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 />.~P.LJr <br />Signature of orporate Officer, Owner, or Designee <br />~/ 1.~~, <br />Date <br />