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-A~ ~- (~P-1"' <br /> ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAM <br />E: Asphalt Specialties Co., Inc. <br />PERMIT NO.: M-2005-059 <br />OPERATION NAME: Nelson Mining Resource <br />ANNIVERSARY DATE: March 1, 2008 <br />ANNiJAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br /> <br />EEB 2 7 2008 t/ <br />®ivision or` Reclamation, "~j <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 date and during the preceding year,- new-disturbances "th`at are anticipate 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 report and annual report man to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous vear and no new changes to <br />the previous year's m;ap 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: Rab Laird <br />Permittee Name: Asphalt Specialties Co., Inc. <br />Address: 10100 Dallas St. <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 />~.. <br />Signature of Corporate Officer, Owner, or Designee <br /> <br />Date <br />