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<br /> <br />ANNiiAi. FF.F, and RF.PnRT RF.Oi1FST RECEIVED <br />PERMITTEE NAME: `Rfocky Mountain Materials & Asphalt, Inc. ~CT 1 1 ~ <br />PERMIT NO.: ~'1-2000-052 Division of iuiinerals anU Geology <br />OPERATION NAME: Coyote Ridge <br />ANNNERSARY DATE: September 11, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <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 attaeh,ynnr revised written anmral rennrf and anmral rennrt map.tn this form- Please note that an <br />adequately labeled map that clearly delineates and includes the 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 />Pennittee Contact: Tom Smith <br />Permittee Name: Rocky Mountain Materials & Asphalt, Inc. <br />Address: 1910 Rand Ave. <br />Colorado Springs, CO 80906 <br />one um er: ) -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 />Signature of Corporate Officer, Owner, or Designee <br />Date <br />