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c <br />~~ ~ ~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: / Southway Construction Company, Inc. <br />PERMIT NO.: M-1987-012 <br /> ~ <br />OPERATION NAME: King Pit <br />ANNIVERSARY DATE: May 27, 2008 <br />ANNiJAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Alamosa <br /> <br />~~~~~~~ <br />._" fl9AY ® ~ <br />~ ~~~$ <br />y - ®~~~ cr ~tcc~G~~Binra <br />"' "' ~aad ~~g~ <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 />-- - - reclamatien accomplished to~ date and during the preceding year, new di'stu`rbanc s `tliaf-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 man are necessary, then no new man 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: Ralph Martinez <br />Permittee Name: Southway Construction Company, Inc. <br />Address: 117 White Pine Dr <br />Alamosa, CO 81101 <br />Phone Number: (719) 589-5103 <br />Fax Number: (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 O er, Owner, or Designee <br />~ ~o ~ <br />Date - <br />