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oq RECEIVED <br />AUG 14 2015 <br />ANNUAL FEE and REPORT REQUEST DIVISlu-i ui nicCL.AMATION, <br />N 8 TY ERALS <br />PERMITTEE NAME: King Mountain Gravel, LLC EE 4W <br />PERMIT NO.: M-1978-314 <br />OPERATION NAME: King Mountain Sand & Gravel Mine <br />ANNIVERSARY DATE: November 22_'� ---�DV <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Routt <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 />man. If no new disturbances or reclamation have occurred during the previous year and no new chances 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 sufficefor a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Kirk J. Eberl <br />Permittee Name: King Mountain Gravel, LLC <br />Address: e. <br />Phone Number: (303) 988-6286 <br />Fax Number: (303) 986-2771 <br />WWI <br />30 3 -- 996 8 5 <br />3u3 - 3L -,-2-/4L,4' <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 Corporate Officer, Owner, or Designee <br />-/4 ( /,/,, "1- 6 1. �'? e <br />Date - <br />