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4;* * Re a <br />ANNUAL FEE and REPORT REOUEST )P <br />PERMI TTEE NAME: A. kh&` Son Trucking & Earthmovin -Die: - <br />PERMIT NO.: M-2002-109 <br />OPERATION NAME: Cucharas Pit <br />11lr eeyy , <br />ANNIVERSARY DATE: January 24, UW A009 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Huerfano <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 />- -reelamation-aeeomplished-to-date-and-during-the-pieced- ing 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 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 year and no new changes to <br />the previous vear's mau are necessarv, then no new map is reauired, 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: Anthony Bletssi ,u <br />Permittee Name: A. -Bs &6;& Son Trucking & Earthmoving, Ifte. - <br />Address: 38043 CR 32.4 <br />Trinidad, CO 81082 <br />Phone Number: (719) 845-8785 <br />Fax Number: 01_1,9j$4`_s <br />7ig- 81-10 - y011-10 <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 />a e of Corporate ficer, Owner, or Designee <br />Date .