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0 <br />.i?AL I~EE and REPORT REQUEST <br />PERMITTEE NAME: '-?ocky Mountain Materials & Asphalt, Inc. <br />PERMIT NO.: VM-1980-189 <br />G i CEa ?v2J <br />4VT ( 22.19 <br />Divi--"-1 C..., ._.,,._...-r, <br />OPERATION NAME: Yoder <br />ANNIVERSARY DATE: October 23, 2009 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: El Paso <br />--- - Accor-ding-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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances-to-affected- -- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new chanEes to the previous vear's man are necessarv. then no new man is reauired. Provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Tom Smith <br />Permittee Name: Rocky Mountain Materials & Asphalt, Inc. <br />Address: 1910 Rand Ave <br />Colorado Springs, CO 80906 <br />Phone Number: (719) 473-3100 <br />Fax Number: <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 <br />en 1 sed. <br />Sign ture of orporate O er, per, or Designee <br />Date <br />M: TERMITIMAS TERDOCUMENTS\NI-AF-04