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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Permittee Contact: Lisa Phillips <br />Permittee Name: Lawrence Construction Company, Inc. <br />Address: 9002 N Moore Road <br />Phone Number: <br />Fax Number: <br />Littleton, CO 80125 <br />(303) 791 -5642 <br />(303) 791 -5647 <br />Si nature of Corpor e Officer or Owner <br />Date <br />AN UAL FEE and R PORT REQUEST <br />�I�wrence Construction Company, Inc. <br />t/ / M- 1974 -041 <br />Lawrence Pit <br />January 29, ` 1 2011. <br />$$791.00 (Due on or before your anniversary date) <br />Douglas <br />FEB 0 71pip <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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 />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 />No Ac ∎v -y <br />o c N 40 MaP <br />