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Y <br />ANNUAL FEE and REPORT REQUEST <br />~. <br />PERMITTEE NAME: Asphalt Paving Company - 2~~7 <br />AUG~• <br />PERMIT NO.: M-2005-066 <br />. -~una,;an. <br />pivis;on w ~~ ~ ~ L'~`.;~ <br />OPERATION NAME: Wattenberg West Sand and Gravel Mine ~;;,:ing 4~. <br />ANNIVERSARY DATE: August 11, 2007 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <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 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 your revised written annual resort and annual resort map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />maD. 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 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: Jeff Keller <br />Permittee Name: Asphalt Paving Company <br />Address: 14802 W. 44th Ave. <br />Golden, CO 89403 <br />Phone Number: <br />Fax Number: <br />(303)279-6611 <br />(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 to this form along with your written report and map. Annual Report instructions are enclosed. <br />~ `~~~ <br />Signature of Corporate Officer, Owner, or esignee <br />dd- ~ --v~ <br />Date <br />