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~~~1 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Haldorson and Sons, Inc. <br />M-2003-037 <br />Haldorson Sand and Gravel Mine <br />December 16, 2004 <br />p~~ <br />N~ <br />~~i~c~~la~ z~~~ <br />DEC "i ; 2G04 <br />$688.00 (Due on or before your anniversary date) <br />Montrose <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 />-reclairiation accomplishes o 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 re,~nrt and annual re,Pn m,~ to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffece for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mark Haldorson <br />Permittee Name: Haldorson and Sons, Inc. <br />Address: P.O. Box 1019 <br />Phone Number: <br />- -Fax Number: <br />Montrose, CO 81402 <br />(970)252-9266 <br />(970)323-5851 - <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 fficer, Owner, or Designee <br />Date <br />