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itz <br />ANNAL FEE and R EPORT REQUEST <br />RECEIVM <br />PERMITTEE NAME: ,C All Rite Paving & Redi Mix, Inc. L 0 7 2011 <br />PERMIT NO.: 41- 1999 -005 Division of Reclamation, <br />OPERATION NAME: North River Pit <br />j Mining and Safety <br />ANNIVERSARY DATE: July 14, 2011 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Otero <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 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 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: <br />I--ierb K.("PeJArsofA <br />Permittee Name: All Rite Paving & Redi Mix, Inc. <br />Address: P.O. Box 1128 <br />Phone Number: <br />Fax Number: <br />La Junta, CO 81050 <br />(719) 383 -2600 <br />(719) 383 -2211 <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 />Ka A <br />Signature of Corporate fficer, Owner, or Designee <br />Date <br />