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er <br />, 1? AANN/UAU FEE and REPORT REOUEST <br />PERMITTEE NAME: ? R E Monks Construction Co. <br />PERMIT NO.: V4-1983-193 <br />OPERATION NAME: Monks Plant No 1 <br />ANNIVERSARY DATE: July 29, 2010 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: El Paso <br />v ??fd <br />J444 <br />Q?g4,9 l Mom <br />afoty n, <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 vear's man are necessarv, then no new man is reauired, 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: Dennis Good <br />Permittee Name: R E Monks Construction Co. <br />Address: P.O. Box 25579 <br />Colorado Springs, CO 80936 <br />Phone Number: (719) 495-3621 <br />Fax Number: (719) 495-0467 <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 />0-0?0 <br />Signature of C tate O ficer, Owner, or Designee <br />-I. `g • \U <br />Date