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i' <br /> ANNUAL FEE and REPORT RE VEST <br /> PERMITTEE NAME: Allen P. Small Trucking&Excavation,Inc. 4),Alrdh9 ,o?�I O <br /> On o�c � <br /> PERMIT NO.: ,- M-2000-103 Mph/n ofR i% <br /> OPERATION NAME: A.P.S.Trucking and Excavating,Inc. 9 aid c�an7 �e <br /> Safet�,bO h <br /> ANNIVERSARY DATE: January 23,2010 "CEWD <br /> ANNUAL FEE DUE: $323.00(Due on or before your anniversary date) <br /> FEB 161010 <br /> COUNTY: La Plata <br /> DlviWn of Reclamation, <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of t ie p , , Woerator <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 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 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: Allen P. S 11 <br /> Permittee Name: Allen P. Small Trucking&Excavation, Inc. p p� <br /> Address: Ten,_.__n_ gnu c Ll G� �'. Y� r 301 R <br /> vtffftn , rn Q1zni _ yftli D 1/ 3 7 <br /> Phone Number: (970) 749-7645 F- C L ✓N G <br /> Fax Number: (970)259-2307 © " a.s 2-3 6 Y F do-7�. <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 /> igna c of Corp rate Officer, Owner, or Designee <br /> Date <br />