2008-12-09_REPORT - M1983176

• Permit No: M1983176
• IBM Index Class Name: REPORT
• Doc Date: 12/9/2008
• Doc Name: Annual Fee/Report/Map
• From: Asphalt Specialties Co., Inc.
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: DB2
• Media Type: D
• Archive: No

dr-
PERMITTEE AME:
PERMIT NO.:
OPERATION NAME:
ANN&rFEE and REPORT REQUEST
K phalt Specialties Co., Inc.
1983-176
dbz
ANNIVERSARY DATE:
ANNUAL FEE DUE
COUNTY:
Speer Mining Resource
200
December 9, 2008 Division ui nectam6gana
Wi!ninq and &f %
$$791.00 (Due on or before your anniversary date)
Adams
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 submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year;-reclamation-thdt?Wil-l- performed'=during=tl3e--deming-year,-the=date-s=for_the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report man to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous year and no new changes to
the previous year's map are necessarv, then no new map is reauired. provided that the Operator shall state
this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the
above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Rob Laird
Permittee Name: Asphalt Specialties Co., Inc.
Address: 10100 Dallas St.
Henderson, CO- 80640
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with youl written report and map. Annual Report instructions are enclosed.
Signature of Corporate Officer, Owner, or Designee
,43
Date