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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />N <br />N AL FEE afdR(PdRT RE UEST <br />fiXZC0 Construction, Inc. <br />I/M-2004-029 <br />AZCO Pit <br />September 24, 2009 <br />RECEIVED <br />AUG 1 <br />zoos <br />.,7,,Divi8ion of Reclamation, <br />Mining and safaty <br />$$323.00 (Due on or before your anniversary date) <br />Fremont <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 peffdrmed" during the coming year,-tlie dates for the 'begiririing - - -' <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: Ronald E. Walker <br />Permittee Name: AZCO Construction, Inc. <br />Address: 2055 US Highway 50 <br />Penrose, CO 81240 <br />Phone Number: (719) 372-6872 <br />Fax Number: (719) 372-0418 <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 />Sign ture of Corporate ficer, Owner, or Designee <br />Date