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x_,-16 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />4,e e <br />ANNUAL FEE and REPORT REQUEST <br />r EVER <br />APC Southern Construction Co., LLC <br />M-2002-118 MAY 2 4 2010 <br />Velarde Pit Din of R_-cL%Tw ion, <br />RAinirog and Suety <br />June 9, 2010 <br />$791.00 (Due on or before your anniversary date) <br />Huerfano <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-durmg=the-preceding-year,--new--disturbances-that-am-a=i&pate-d-tsoc;cur'---- <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, an t e ate active operations ceasedr 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 vear's man are necessarv, then no new man 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: <br /> <br />Permittee Name: APC Southern Construction Co., LLC <br />Address: 14802 W 44th Ave. <br />804-03- <br />Phone Number: CF.PR.telephone_number <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 enclosed. <br />CSi- atu7of/Coirporate Officer, Owner, or Designee <br />s? ?G <br />Date