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<br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />P~ ~R~ <br />ANNUAL FEE and REPORT REQUEST <br />Montezuma County ~~ <br />M-1999-077 <br />Ormiston Gravel Pit <br />October 25, 2007 <br /> <br />SEP 1 q 2007 <br />AAtldrgot~et ~ <br />$$791.00 (Due on or before your anniversary date) <br />Dolores <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated moo. If no new disturbances or reclamation have occurred durinc the previous year and no <br />new chances to the previous year's map are necessary, then_no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following petrnittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lloyd Everett <br />Permittee Name: Montezuma County <br />Address: 1680 pp f~~iC~ ~Or~-C~ Fl'~Ior~S ~~~ <br />r~ I~e~d'~5 I~oAa- -- - <br />Cortez, CO 81321 <br />Phone Number: (970) 565-8666 <br />Fax Number: (970) 565-8252 <br />If you have addifional 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 <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:NERMI'MIASTERDOCUMENTS~h1-AF-04 <br />