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R.v-'-W.QT <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />? Hocker Construction, LLP <br />?M-1977-446 <br />Ignacio Pit <br />December 30, 2010 <br /> <br />J 'rN /(f ? P N <br />Fit 2. ? <br />$791.00 (Due on or before your anniversary date) <br />La Plata <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 />-- -----reclamationr-accomplished`t'-date an?dri mg be preceding year,- new distur antes t at 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 vour revised written annual report and annual report may 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 may 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: Roy oc ?r, <br />1. kaj <br />Permittee Name: Hoc 4r Construction, LLP <br />Address: P.O. Box 627 <br />Ignacio, CO 81137 <br />Phone Number: (970) 563-9533 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or c t to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of 4565rporate Officer, Owner, or Designee <br />'Ibli <br />Date