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<br />/ ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: / Asphalt Constructors, Inc. <br /> <br />PERMIT NO.: /M-1477-053 <br />OPERATION NAME: Lyle Smith Pit <br />ANNIVERSARY DATE: December 23, 2006 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Costilla <br />Y~ ~I'L <br />fZ'~~~ <br />RE~E-~.~ED <br />~ DEC 18 200& <br />Droision of R®clematbn, <br />Mining and Safety <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.accomplished_to_daze_and..during rhr ~~P~ling_yeac,_new_distucbances_that-are-anticipated-to-eccu~ - - <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 map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, resort, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may cuff ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Todd A.Stockebrand <br />Permittee Name: Asphalt Constructors, Inc. <br />Address: 7040 Hwy. 160 W. <br />Alamosa, CO 81101 <br />Phone Number: (719)589-6671 <br />Fax Number: (719) 589-0927 <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 />Gtdurz~~/>d~- <br />Signature of Corporate Officer, Owner, or Designee <br />!2 iyv6 <br />Date <br />