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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />,~~ g ~~ <br />ANNUAL FEE and REPORT REQUEST <br />.i <br />Riverside Aggregates, L.L.C. <br />~M-1985-014 <br />Bonnie Earl Pit <br />Apri112, 2008 <br />~~ `t~ <br />~IPR 0 9 2008 <br />Davisior~ oti ~e~;ceamation, <br />l/ Mining and Safety <br />$$323.00 (Due on or before your anniversary date) <br />Bent <br />/~ <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />-land; reciamation-accomplished-to date-and during the preceding year, new disturbances-that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />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: Rudy Torres <br />Permittee Name: Riverside Aggregates, L.L.C. <br />Address: 1750 Rd. HH <br />Phone Number: <br />Fax Number: <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 <br />e d. <br />Si ture of Corporate Officer, Owner, or Designee <br />~~~ o~ <br />ate <br />Lamar, CO 81052 <br />(719) 336-7361 <br />M:~PERMITIMASTERDOCUMENTSVvt-AF-04 <br />