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i III IIIIIIIIIIIII III <br /> ANN-UAL FEE and REPORT REQUEST <br /> PERMITTEE NAME: Centennial Materials, Inc. RECEIVED <br /> PERMIT NO.: M-1988-044 <br /> OPERATION NAME: Coal Creek Resources MAR 2 2 2001 <br /> ANNIVERSARY DATE: March 28, 2001 Division of Minerals and Geology <br /> ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br /> COUNTY: Arapahoe <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 perfoi-�Prl during the coming year, the dates for the <br /> beginning of--tive operations, and the date active operations ceascu' for the.year. if any. <br /> Please attach your revised written annual report and annual report -w-n to this form. Please aoic .hu: !n <br /> adequately labeled neap that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Donald L. Opheim <br /> Permittee Name: Centennial Materials, Inc. <br /> Address: 1101 Topeka Wy. <br /> Castle Rock, CO 80104 <br /> Phone Number: (303)688-1 183 <br /> Fax Number: (303) 660-9146 <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 <br /> enclosed. <br /> Signature of Co orate Off-if er or Owner <br /> 2 0 <br /> Date <br /> WPERM ITWASTERDOC UM ENTS W-AF-01 <br />