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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />AF T <br />ANNUAL FEt and REPORT REQUEST <br />01-4 lco Inc. <br />Z.. Rocky Ford East Pit <br /> <br />February 22, 2011 <br /> <br />$$791.00 (Due on or before your anniversary date) <br />Otero <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-aceomplished to- date and during-the preceding year-Dew disturbances that are anticipated to occur <br />----during th <br />_u.pconung_year,_reclamation that-will be_perfoxmd_dunng_the coming_yearrthe_7dates1 the beginn.ing_-_ <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: Tom Brubaker <br />Permittee Name: Valco Inc. ? <br />Address: 12753 S. Parker Rd. <br />Parker, CO 80134 -**'? <br />Phone Number: (303) 248-3590 <br />Fax Number: (800) 332-1652 <br /> <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 />4gna?ture of Corporate Oor Designee <br />2! 2-C) <br />Date