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/ <br />AL FEE and PJ <br />ORT REOUEST <br />PERMITTEE NAME: Southern Construction Co., LLC RECEIVED <br />PERMIT NO.: Z2000-118 OCT 2 <br />OPERATION NAME: Pino Pit i?+f l of fteg1P#1 , <br />ANNIVERSARY DATE: November 15, 2010 f stn <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: 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 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 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: James MacDonald <br />Permittee Name: <br />APC Southern Construction Co., LLC <br />Address: <br />Phone Number: <br />Fax Number: <br />14802 W 44th Avenue <br />Golden, CO 80403 <br />(303) 279-6611 <br />(303) 279-6216 <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 />a re of Corporate Officer, Owner, or Designee <br />/o b Y1 40 <br />Date