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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <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 />—_ reclamation_ accomplished -to- date - and - during - the - preceding year- new - disturbances-- that -- are- antieipated=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: Joseph Febbraro, Jr. <br />Wzi) V/s7 4 !e <br />Permittee Name: Febbraro Construction Co. <br />Address: 2010 Santa Fe Trail <br />Phone Number: <br />Fax Number: <br />Trinidad, CO 81082 <br />(719) 846-7789 <br />(719) 846 -6537 <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 />Date <br />,/ <br />Ar <br />Corpo . to Officer, Owner, or`'' esignee <br />ANN AL FEE and REPOR REQUEST <br />bbraro Construction Co. <br />V-I / Fe- 2004 -028 <br />The Broyles PitBroyles Pit <br />September 21, 2011 <br />$$323.00 (Due on or before your anniversary date) <br />Las Animas <br />Ala <br />itece <br />SEP `I f ?n h 9 <br />Division of Reclamagien, <br />Mining and Safety <br />