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PERMITTEE NAME: M B lder's Aggregate, Inc. <br />PERMIT NO.: 1M -1981 -112 <br />OPERATION NAME: Builders Aggr Pit <br />ANNIVERSARY DATE: September 1, 2011 <br />ANNUAL FEE DUE: <br />COUNTY: <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 />reclamati_on_accomplished_tn cute and during the precedingyear ,_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: James S. Miner <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Builder's Aggregate, Inc. <br />910 West Beaver Ave <br />Fort Morgan, CO 80602 <br />(970) 867 -6334 <br />i / /LL�i I / iA_ / / <br />ature of Corporate Officer, Owner, or Designee <br />AN UA FEE and REP REQUEST <br />$$791.00 (Due on or before your anniversary date) <br />Morgan <br />"ECELWPD <br />SFP 1 5 7(111 <br />Division or Keclamatlof, <br />Mining and Safety <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 />