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t., co <br />PERMTITEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~/~ ANNTIAi, FFF, and RF,PtiRT RF.t7iiF.ST <br />Robins Construction Co. LLLP <br />!/ M-2002-014 <br />Robins Pit No. 1 <br />May 16, 2006 <br />RECEIVED <br />`' MAY ff.12~6 <br />W iuisien of Minerals and lieolopY <br />$281.00 (Due on or before your anniversary date) <br />Conejos <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 />rec]aroation-acs~p'~-'-,~s~.~-~;-Bate-Bud-dnrtng-the-preceding-year,--new 3ishrrbances-tliai ate aY3tiLipdted-fo 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 far the year, if any. <br />Please attach ynnr revised written annual report and anmral re~nrt ma,~n, to 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: Randy Robins <br />Permittee Name: Robins Construction Co. LLLP <br />Address: P.O. Bax 212 <br />Antonito, CO 81120 <br />Phone Number: (719) 376-2351 _ <br />Fax Number: (719) 376-2651 <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 aze enclosed. <br />Signature of rporate fficer, Owner, or Designee <br />gl~~ <br />Date <br />