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<br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />RV *- Wr <br />ANNUAL FEE and REPORT REOUEST <br />VAPC Southern Construction Co., LLC <br />M-2000-118 ? <br />Pino Pit <br />November 15, 2009 <br />$791.00 (Due on or before your anniversary date) <br />Huerfano <br />I?L$o;L W ggTk r4 vL <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 performed during the coming year, the dates for the beginning___ <br />--of active operations;-and-the-date-active-operatiuns cea ese -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 may are necessary, then no new may 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 suf 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: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />&04Q' (T-cy;- ?Q'-fo3 --- - -- <br />J ry? ry) O c- 00%4Cj <br />APC Southern Construction Co., LLC <br />303- 66// <br />30,3- a-29-6Dl 6 <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 />gSign Frenoef!!!Cnorporate Officer, Owner, or Designee <br />zD T? <br />Date <br /> <br />ow <br />?7 <br />? ? <br />