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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />7- <br />AN AL FEE and REPORT REQUEST <br />ontinental Materials Corporation <br />:,m/-2001-005 <br />Grisenti Farms Gravel Pit <br />May 23, 2011 <br />b01 k °A--- <br />RECEIVED <br />1? <br />MAY <br />Division of Reclamation, <br />-79 Mining & Safety <br />$$791.00 (Due on or before your anniversary date) <br />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_acccomplished 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 comiag-year,-the dates- for-the-beginning - of active operations, and the date active operations ceased for the <br /> 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 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: Andre Laroche <br />Permittee Name <br />Address: <br />Phone Number <br />Fax Number: <br />Continental Materials Corporation <br />444 E. Costilla St. <br /> <br />Colorado Springs, CO 80903 <br />(719) 475-0700 <br />(719) 475-0226 <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 />--:11 L11 WS16;ez69rAq?55: <br />Signature of Corpo Officer, Owner, or Designee <br />Date <br />VENDOR <br />DICE DATE 'DISC. AMT.-.-._ <br />1 (? 717/-1-00 <br />- <br />APPROVED B