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iF 7- <br />AE°anO RT RE VEST <br />ANNU <br />PERMITTEE NAME: cky Mountain Materials & Asphalt, Inc. 4• R . , <br />cr 4 \, <br />PERMIT NO.: M-2000-052 <br />OPERATION NAME: Coyote Ridge ?SEP 02 2010 <br />ANNIVERSARY DATE: September 11, 2010 DWision `" I ICUO .. <br />'punning and Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary d <br />COUNTY: Fremont <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- --agtisipated 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 map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />mat). 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: Tom Smith <br />Pennittee 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 />Signature o Corpor to O ce Owner, or Designee <br />Date <br />