2007-02-21_REPORT - M2005059

• Permit No: M2005059
• IBM Index Class Name: Report
• Doc Date: 2/21/2007
• Doc Name: Annual Fee/Report/Map
• From: Asphalt Specialties Co., Inc.
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
t/Asphalt Specialties Co., Inc.
x/141-2005-059
Nelson Mining Resource
March 1, 2007
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D/`'`'~ c`R-~_-.r. iron,:
$$688.00 (Due on or before your anniversary date)
Weld
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
--shall-submit-the annual--fee,-a-report-and map-showing-the,-extent-of current-disturbances-to affected-land,-----
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual report and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous vear and no new chances to
the urevious year's maa are necessary, then no new map is required, urovided that the Ouerator shall state
this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the
above elements may since for a written report.
Division records indicate the following permittee contact information, Please verify and make any necessary
changes:
Permittee Contact: ~'
Rob La~rr~
Permittee Name: Asphalt Specialties Co., Inc.
Address: 10 ] 00 Dallas St.
Phone Number:
Fax Number:
Henderson, CO 80640
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. ,
~~~
Signature of Corporate Officer, Owner, or Designee
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Date