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r"~ <br /> ANNiJAL FEE an PORT QUEST <br />PERMITTEE NAME: ~uburban Sand & Gravel Ca. <br />PERMIT NO.: (/~VI-1979-195 ~~~~ ~\ ~~ <br />OPERATION NAME: Road Runner Rest `~' Q'~ 2 9 2~~~ <br />ANNIVERSARY DATE: January 28, 2007 Dy'v'~ion of Reclamation, <br />/ Mining and Safety <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Adams <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, 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 aze 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 man 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 disturbapces or reclamation have occurred durinc the previous year and no new chances to <br />~eprevious year's map are necessary~theu no pew 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 petmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Dean H. Craft <br />Permittee Name: Suburban Sand & Gravel Co. John e . Bambei , sr. <br />Address: 5400 Fenton St. Chief of Engineering <br /> 1600 W. 12th Ave. <br /> Arvada, CO 80002 Denver , Colorado 80204 <br /> <br />Phone Number: (303) 421-0720 (303) - 628-6669 <br />Fax Number: (303)467-0411 (303) - 628-6851 <br />If you have additional cottunents 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 />Si a re of Corporate O r, Owner, or Designee <br />~-zS-o2 <br />Date <br />