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~a ion <br />~irvl W <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />v ANNUAL FEE and REPORT REQUEST <br />t/ Asphalt Paving Company <br />M-1990-098 <br />Perry Pit <br />September 29, 2006 <br />RECEIVED <br />.~~~? n ? ,n~5 <br />Division of Reclamation, <br />Mining and Safety <br />$688.00 (Due on or before your anniversary date) <br />Weld <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 lhe-anntiai° fee; a-re-yart-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 far 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 moo to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />moo (All are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />since jor a written report, <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Greg Gerganoff <br />Permittee Name: Asphalt Paving Company <br />Address: 14802 W. 44th Ave. <br />Golden, CO 80403 <br />Phone Number: <br />Fax Number: <br />(303) 279-6611 <br />(303)279-6216 <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 o~Co orate Officer, Owner, or Des_ <br />~~ ~-oar' <br />Date <br />