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1/ ` -" <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />A. Blasi & Son Trucking &Earthmoving, Inc. <br />M-2002-109 <br />Cucharas Pit <br />January 24, 2004 <br />$281.00 (Due on or before your anniversary date) <br />Huerfano <br />~'iMl~- <br />RECEIVED <br />MAR 1.9 2004 <br />Division of Minerals & rjtp~, <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-aceomplished-to~Iate-and-during-ihe-prece~ling~ear; new-disturbances-that~re-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 reQnrt and annual rennrt man to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Anthony Blassi <br />Permittee Name: A. Blassi & Son <br />Trucking & Earthmoving, Inc. <br />Address: 38043 CR 32.4 <br />Trinidad, CO 81082 <br />Phone Number: (719) 845-8785 <br />Fax Number: (719) 845-8786 <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 />~~~ <br />Signature o orporate Officer, Owner, or Designee <br />Date <br />M:\PERMITU1ASTERD000M ENTSVN-AF-01 <br />