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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Asphalt Specialties Co., Inc. <br />M-1983-176 <br />Speer Mining Resource <br />December 9, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Adams <br />Ft~C;~~i/~® <br />DEC 0 9 200~i <br />pivi5ion of Minerals and Geology <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 />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 anneal rennrt and anneal report m ern 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: Rob Laird <br />Petmittee Name: Asphalt Specialties Co., Inc. <br />Address: 7321 E. 88th Ave., Ste. 100 <br />Henderson, CO 80640 <br />_ Phone Number: 303 289-8555 ` _ <br />Fax Number: (303) 289-7707 <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 />_~~1~~ ~fl~it~t~ /yl(-ifs'. <br />Signature of Corporate Officer, Owner, or Designee <br />- 3-0~ <br />Date <br />M:\PERMITMASTERDOCUMENTSUI-AF-01 <br />