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r . ,Q/ <br /> <br /> ANNUAL FEE and REPORT REQUEST ~Q <br />i <br />"_ <br />PERMITTEE NAME: Rocky Mountain Materials & Asphalt, Inc. / <br />RECEIVED / <br />PERMIT NO 2000 <br />M <br />052 / <br />.: - <br />- SEP 2 8 2001 <br />OPERATION NAME: Coyote Ridge Division of Reciantetion~ <br />ANNNERSARY DATE: September 11, 2007 Mining and Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />_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 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 during the previous vear and no new chanties to <br />the previous year's moo are necessary. then no new moo 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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Tom Smith <br />Permittee Name: Rocky Mountain Materials & Asphalt, Inc. <br />Address: 1910 Rand Ave. <br />Colorado Springs, CO 80906 <br />Phone Number: (719) 473-3100 <br />Fax Number: (719) 473-3109 <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 />Sign to ure of Corporat~E Offi fir, Owner, or Designee <br />Date <br />