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<br />P?L__ <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Aeestway Paving Company <br />PERMIT NO.: 1M-1977-315 <br />OPERATION NAME: Pit No. 1 <br />ANNIVERSARY DATE: April 23, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <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 />keclamation .accorn ished 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 y" ear, the dates" fo? - r tTie '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 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: Carl V. Hill <br />Permittee Name: Bestway Paving Company <br />Address: P.O. Box 336633 <br />Greeley, CO 80633 { <br />Phone Number: (970) 381-5087 <br />Fax Number: (970) 353-5089 <br />If you have d ' ional comments and/or information that should be provided to the Division, please provide it <br />below or att to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signa r of orp yicer, Owner, or Designee <br />q '9 9 <br />Date