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<br />ANNUAL FEE and REPORT REQUEST <br /> <br />PERMTTTEE NAME: Rocky Mountain Materials & Asphalt, Inc. RECEIVED <br />PERMIT NO.: M-2000-052 <br />OPERATION NAME: Coyote Ridge SEP 1 1 2002 <br />ANNIVERSARY DATE: September 11, 2002 Division of Minerals and Geology <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />According to C.R.S. 34-32.5-116 o"r C.R.S. 34-32-I 16, 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 />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 [he 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 resort mao to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate [he 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 />~~ <br />Signature of Corporate Officer, Owner, or Designee <br />~~~o-aa <br />Date <br />M iPERMITVv1A5TERD000M ENTSNI-AF-01 <br />