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i~F 9r Q~T <br />ANNUAL FEE and REPORT REQUEST <br />RECENED <br />PERMITTEE NAME: Venable's Welding &Roastabout, Inc. <br />PERMIT NO.: M-2004-043 / SEP 212007 <br />OPERATION NAME: Valco T Pit Division of ReGamation, <br />Mining and Safety <br />ANNIVERSARY DATE: October 19, 2007 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Las Animas <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 pem>it, 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 yeaz, new disturbances that aze 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 durine the previous vear and no new changes to <br />the previous year's man 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Scott Venable <br />/~r k~. (/Pr/~rJIE~ <br />Permittee Name: Venable's Welding &Roastabout, Inc. <br />Address: 1041 N Dumas Ave <br />Dumas, TX 79029 <br />Phone Number: <br />Fax Number: <br />8o6-q 3S ' ~5~ q <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 />J2~~~i..~~2~~ <br />Signature of Corporate Officer, Owner, or Designee <br />-~g~o <br />(806) 935-3868 <br />Date <br />