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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />?4' ? , a2T <br />ANNUAL FEE and REPORT REOUEST <br />APC Southern Construction Co., LLC <br />M-2002-118 <br />Velarde Pit <br />June 9, 2009 <br />RECOVED <br />-/ MAY L 6 2009 <br />Division of Rec wngtM, <br />.% 11 Abg and SO* <br />$791.00 (Due on or before your anniversary date) <br />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 />- -re lamation=accomplished-ta-date-.nd-iuring_the-Mecedi_ na year new dic irb _ na ces 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: Richard L. Pounds <br />Permittee Name: APC Southern Construction Co., LLC <br />Address: P10-BOX-969 <br />Phone Number: (7 9M2-69 /4 <br />Fax Number: <br />I g(W0 -?- LA-) qq' - A ke <br />(jQ 9" . 02) ?s o <br /> <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 />Signature of Corporate facer, Owner, or Designee <br />Date