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A~ i~PT <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ,/ A. $iassr& Son Trucking & Earthmoving,-Ies. <br />PERMIT NO,: ~M-2002-109 <br />OPERATION NAME: Cucharas Pit <br />ANNNERSARY DATE: January 24, 2007 <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: Huerfauo <br /> <br />~~ 1 ~ 2007 <br />ision of Reclamation, <br />Mining and Safety, <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, 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-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 vour revised written annual resort and annual report man 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 vear and no new chances 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 cuff ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />PermitteeContact: Anthonyl3lassi Q)R5i <br />Pennittee Name: A. Blasi & Son Trucking & Earthmoving, -Ins- <br />BIASi 1-I.C~ <br />Address: 38043 CR 32.4 <br />Trinidad, CO 81082 <br />Phone Number: (719) 845-8785 <br />Fax Number: (719) 845-8786 <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 />~~~~~ ~~ <br />Signature of Corporate Officer, Owner, or Designee <br />Date ~~~ <br />