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ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Southway Construction Company, Inc. <br />M-1987-012 <br />King Pit <br />May 27, 2002 <br />' ~_ <br />MAY 2 8 2002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Alamosa <br />According to C.R.S. 34-32.5-1 ] 6 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 yeaz, 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 [he date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report map 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: Kris DeGolyer <br />Permittee Name: Southway Constmction Company, Inc. <br />Address: 117 White Pine Dr. <br />Alamosa, CO 81101 <br />Phone Number: (719) 589-5103 <br />Fax Number: (719) 589-5522 <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 />Signature of Corporate Officer r Owner <br />Date <br />M 1PERMIT V.1ASTERDOCIIMENTSNI-AF-01 <br />