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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />r <br />AN UAL FEE and REPORT REQUEST <br />Dave Direzza <br />YM-1984-028 <br />Direzza Pit <br />May 1, 2010 <br />MKOVED <br />/APR 2 9 2010 <br />piv"n of i-?ccisam&Con, <br />nL Wing and Safety <br />$$323.00 (Due on or before your anniversary date) <br />Bent <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 ac-c-omphshed to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed <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: ---9e--Permittee Contact: Daniel DiRezza %? ICAO 11 `" <br />Permittee Name: _Daue Direzz? L ? j /R AM I L &TA)&f5fiP <br />Address: 4815 Hwy 194 S fl M E <br />Las Animas, CO 81054-9411 S''I <br />Phone Number: (719) 456-2266 5-441 <br />Fax Number: (719) 456-2266 ?,4141Z-- <br />If y u have additio l comments and/or information that should be provided to the Division, please provide it <br />b now or attac4 At o t is form alongwith your written report and map. Annual Report instructions are enclosed. <br />R <br />ignature of Co orate Officer, Owner, or Designee ' C <br />O <br />-- 0 <br />)at