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<br />n? <br />AL FEE and REPORT REQUEST <br />PERMITTEE NAME: Rocky Mountain Materials & Asphalt, Inc. RE' <br />PERMIT NO.: "M-1980-193 " (--"v 2 3 <br />OPERATION NAME: Sokol Pit Di.yisi: n :u;if;; <br />ANNIVERSARY DATE: October 23, 2010 4-0 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: El Paso <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-antirtpated._to_occur 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 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: Rob Mangone <br />Permittee Name: Rocky Mountain Materials & Asphalt, Inc. <br />Address: 1910 Rand Ave <br />Colorado Springs, CO 80906 <br />Phone Number: (719) 473-3100 <br />Fax Number: (719) 473-3109 <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 />V <br />Signature of Corporate Off er, caner, or Designee <br />Date <br />