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o/C <br />? <br />ANNUAL FEE and REPORT REQUEST lO <br />CEP 2 P nog <br />PERMITTEE NAME: Febbraro Construction Co. <br />Divisrorl ui Rec;iv,'nation, <br />PERMIT NO.: M-2004-028 Mining and Safety <br />OPERATION NAME: The Broyles Pit <br />ANNIVERSARY DATE: September 21, 2008 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Las Animas <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_ o-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 beginnin <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour 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 year and no new changes to <br />the previous year's map are necessary, then no new may 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: Joseph Febbraro, Jr. <br />Permittee Name: Febbraro Construction Co.?? /ST(?i?Gv <br />Address: 2010 Santa Fe Trail <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-7789 <br />Fax Number: (719) 846-6537 <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 />C Si ature f Corpo ate Officer, Owner, or esignee <br />YDate <br />