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KIP *- R?-r <br /> ANNUAL FEE and REPORT RIEOOUEST <br />P ?C? <br />ERMITTEE NAME: Asphalt Constructors, Inc. ? <br />PERMIT NO.: M-2001-069 -? <br />OPERATION NAME: Del Norte West Valley Pit <br />ANNIVERSARY DATE: November 5, 2008 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Rio Grande <br />2003 <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 />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 attach your revised written annual report and annual report man 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 year and no new changes to <br />the previous year's map are necessary, then no new map 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: Todd Stockebrand <br />Permittee Name: <br />Address: <br />Phone Number: <br />Asphalt Constructors, Inc. <br />7040 Highway 160 West <br />Alamosa, CO 81101-8519 <br />(719) 589-6671 <br />Fax Number: (719) 589-0927 <br /> <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 />Ll__ f I YYrit4,1 6 <br />Signature of Corporat Officer, Owner, or Designee <br />1# "Q <br />Date