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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />T <br />ANNUAL FEE and REPORT REOUEST <br />Allen P. Small Trucking & Excavation, Inc. <br />M-2000-103 L,-' <br />A.P.S. Trucking and Excavating, Inc. <br />January 23, 2009 <br />$323.00 (Due on or before your anniversary date) <br />La Plata <br />CE v E® <br />FEB 0 2 2009 <br />Division of Reclamation, <br />Mining and Safety 31 <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-aecomplished-to-date-and-dur-ing-the-preeed-ing-year-,-new-distur-banees-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 may are necessary, then no new may 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: Allen P. Small <br />Permittee Name: Allen P. Small Trucking & Excavation, Inc. / <br />Address: <br />Durango, CO 81301 <br />Phone Number: P-7??-207 <br />Fax Number: (970T759-- 30 ---' <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 />S' re orpor a Officer, Owner, or Designee <br />Date