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ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Fr mont Paving & Redi-Mix Inc <br />PERMIT NO.: -2007-006 <br />OPERATION NAME: Ted Franciscotti Pit #1 <br />ANNIVERSARY DATE: June 17, 2011 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Huerfano <br />kIr- <br />RECEIVED <br />'--'JUN 15 2011 <br />Division of kecorAion. <br />Mining and Safety <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 man 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: John P. Ary <br />Permittee Name: Fremont Paving & Redi-Mix Inc <br />Address: 839 Mackenzie Ave <br />P.O. Box 1720 <br />Canon City, CO 81215 <br />Phone Number: (719) 275-1280 <br />Fax Number: (719) 275-8897 <br />If you have additional comments and/or information that should be <br />below or attach it to this form along with your written report and map. <br />Si re of Corporate Officer, Owner, or Designee <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />Date