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0/4- <br />A bm k <br />i <br />1 <br /> ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br /> ? <br />PERMITTEE NAME, To y J Beltramo & Sons, Inc. <br />' <br />"8 <br />101 <br />AR 211 <br />PERMITNO.: ? <br />M-i <br />' M <br />OPERATION NAME: Cesar Pit / pivision of Reclamation, <br />ANNIVERSARY DATE: March 29, 2011 ?b Mining & Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Pueblo <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 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 />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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Robert D. Beltramo <br />Permittee Name: Tony J Beltramo & Sons, Inc. <br />Address: 1541 Stockyard Road <br />Pueblo, CO 81001 <br />Phone Number: (719) 5444744 <br />Fax Number: (719) 544-0247 <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 of Corpor to Officer, Owner, or Designee <br />?0 <br />Date