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j?F '?- Rp-(, <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />Asphalt Paving Company <br />M-2005-066 <br />Wattenberg West Sand and Gravel Mine <br />August 11, 2008 <br />$791.00 (Due on or before your anniversary date) <br />Weld <br />RECEIVED <br />JUL 14 2m u-? <br />Division or Reclamation, <br />Kning and Safety L'? <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 shall <br />submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation <br />accomplished to date-and during the preceding year, new disturbances that are anticipated to occur during_the upcoming <br />year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the <br />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 & Fee <br />requirement is not met until we have received the following components: fee, report, and associated map. If no <br />new disturbances or reclamation have occurred durinz the previous year and no new chances to the previous <br />vear's map are necessarv, then no new man is required. provided that the Operator shall state this in the Annual <br />Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary changes: <br />Permittee Contact: Jeff Keller <br />NJc, !'K /11c,r`/.I ,-, <br />Permittee Name: Asphalt Paving Company <br />Address: 14802 W 44th Ave <br />Golden, CO 89403 <br />Phone Number: (303) 279-6611 <br />Fax Number: (303) 279-6216 <br />If you have additional comments and/or information that should be provided to the Division, please provide it below or <br />attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or esi <br />7-// <br />Date