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r- <br />. ~. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />III IIIIIIIII 1'11111 <br />ANNUAL FEE and REPORT REQUEST RECEIVED <br />Asphalt Paving Company <br />M-1983-089 <br />Tomah Site <br />November 8, 2001 <br />NOV 0 8 2001 <br />Olviaion of Minerals and GaoloBY <br />$b88.00 (Due on or before your anniversary date) <br />Douglas <br />According to C.R.S. 34-32.5-1 16 or C.R.S. 34-32-1 16, 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 [hat 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 your revised written annual report and annual report maa to this form. Please mote that nn <br />adequately laheled map that c[enrly delineates and includes the above elements may since for n x~rittert report. <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permiuee Contact: James R. Krattenmaker <br />Permittee Name: Asphalt Paving Company <br />Address: 14802 W. 44th Ave. <br />Golden, CO 80403 <br />Phone Number: (303) 279-6611 <br />Fax Number: (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 [o [his form along with your written report and map. Annual Report instructions are enclosed. <br />~N~ <br />Signature of Corporate O r or Owner <br />Date <br />M: ~P E R M11 I TU1.\ ST E R DOC U Al E NTSNt-A F-U I <br />