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,'A fr <br /> ANNUAL FEE and REPORT REOUEST <br /> <br />PERMITTEE NAME: fl-Lawrence Construction Company, Inc. <br />PERMIT NO.: ?M-1974-041 <br />OPERATION NAME: Lawrence Pit <br />ANNIVERSARY DATE: January 29, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Douglas <br />co ` <br />oiyAN v9 ?049 <br />4*14V ana ?amaaon <br />Sad , <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 to date and during the preceding year, new disturbances that are anticipated to occur <br />during the -upcoming year, rec amation -that-wi-l-l-be-performed-during the-coming-yea r, 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 vear 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: Lisa Phillips <br />Permittee Name: Lawrence Construction Company, Inc. <br />Address: 9002 N Moore Road <br />Littleton, CO 80125 <br />Phone Number: (303) 791-5642 <br />Fax Number: (303) 791-5647 <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 />Signat re o 'Corporate Officer, Owner, or Designee /e, AAPe <br />I r 7_ ° i <br />Date <br />U