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<br />11 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Ar . 14im <br />f <br />ANNUAL FEE an T RE <br />O VEST <br />Lawrence Construction Company, Inc. <br />lll"??? a&1974-041 <br />Lawrence Pit <br />January 29, 2010 <br />RECEIVED <br />,QN 2 0 2010 <br />Division or Kedamation, <br />.v Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Douglas <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 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: Lisa Phillips <br />Permittee Name: Lawrence Construction Company, Inc. <br />Address: 9002 N Moore Road <br />Littleton, CO 80125 <br />Phone Number: <br />Fax Number: <br />(303) 791-5642 <br />(303) 791-5647 <br />If you have additional comments and/or information that should be <br />below or attach it to this form along with your written report and map. <br />iLl) <br />Signature of Cor orate Officer, Owner, or Designee <br />/ 3 /V <br />Date <br /> <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed.