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I <br />PERMITTEE NAME: <br />PERMIT. NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~a~o <br />// <br />ANNU E add RE OR REQUEST <br />-' Southway Construction Company, Inc. <br />~ M-1987-040 <br />Costilla Pit <br />May 21, 2008 <br />$$323.00 (Due on or before your anniversary date) <br />Costilla <br />t ~~~~ <br />- WIAY 0 ~ 2008 <br />rr~~bisiesn cfi ~teclamation, <br />r" Aliining and Safety <br />_ __According to C.R..-S-34-32.5-11-6-or- C-.R.S.-34-32-1-1~-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 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, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes 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: <br />Permittee Name <br />Address: <br />Phone Number: <br />Fax Number: <br />Ralph Martinez <br />Southway Construction Company, Inc. <br />117 White Pine Dr <br />Alamosa, CO 81101 <br />(719) 589-5103 <br />(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 Offi ,Owner, or Designee <br />Date <br />