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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />?16-r <br />ANN AL FFEE hand REPORT REQUEST <br />PrTl ny J Beltramo & Sons, Inc. <br />L,M-1998-101 <br />Cesar Pit <br />March 29, 2009 <br />$$791.00 (Due on or before your anniversary date) <br />Pueblo <br /> <br />I?If, , <br />kIFEE 2 6 ?009 <br />I Division of Reclamation, <br />p Mining and Safety <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, 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 may 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 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: Robert D. Beltramo <br />Permittee Name: Tony J Beltramo & Sons, Inc. <br />Address: 1541 Stockyard Road <br />Pueblo, CO 81001 <br />Phone Number: (719) 544-4744 <br />Fax Number: (719) 544-0247 <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 />Sig ature of Corporate Officer, Owner, or Designee <br />?g ? 09 <br />Date