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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />RZFbraro Construction Co. <br />004-028 <br />The Broyles Pit <br />September 21, 2010 <br />$$323.00 (Due on or before your anniversary date) <br />Las Animas <br />RECTEIVED <br />ISE <br />V P 15 2010 <br />.V M kdng and Saf-+ <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 />- - reelamat-ion-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=tire?-b-egimiing-- <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 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: Joseph Febbraro, Jr. <br />Permittee Name: Febbraro Construction Co. W-ae4AMZQ T:f D -rV <br />Address: 2010 Santa Fe Trail i3-new <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-7789 o I,L <br />Fax Number: (719) 846-6537 <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 />gnatur f Co rate Officer?Owner or Designee <br />IX-4 o112 <br />Date