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f Z? <br />r / <br />and PORT REOUEST <br />o? <br />PERMITTEE NAME: s alt Specialties Co., Inc. RECEIVED <br />0 14 <br />PERMIT NO.: 1983-176 ` DEC 0 % [ U 1 t9 <br />OPERATION NAME: Speer Mining Resource i Division of Reclamation, <br />ANNIVERSARY DATE: December 9, 2010 c!( <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Adams <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 year'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 Laird <br />Permittee Name: Asphalt Specialties Co., Inc. <br />Address: 10100 Dallas St. <br />Henderson, CO 80640 <br />Phone Number: <br />Fax Number: <br />(303) 289-8555 <br />(303) 289-7707 <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 />Signature of Corporate Officer, Owner, or Designee <br />Z- !?7 - 2E?O/r <br />Date