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PERMITTEE NAME <br />PERMIT NO.: <br />Pjr +R <br />ANNUAL FEE and REPORT REOUE?SST-- <br />Consolidated Constructors, Inc. <br />M-2003-003 .? <br />?/ JUN 12 2009 <br />OPERATION NAME: Amzak Pit DMOD" Of . RO6?A' MOV and ANNIVERSARY DATE: July 2, 2009 Y" <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: La Plata <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 />-- nelaniat-ieii-acconiphshed-to=date ;-and-during=the-preceding--ycar,9 now-disturbances-that are-anticipated to-occar -- _- <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 vear's man are necessarv, then no new man 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 suff ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joe Kozimor <br />Permittee Name: Consolidated Constru for c <br />Address: P.O. Box 629 <br />Farmington, NM 87499 <br />Phone Number: <br />Fax Number: <br />(505) 326-7771 <br />(505) 326-7774 <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 Co or e O `cer, Owner, or Designee <br />Date