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<br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />.~ ~ ~ ~ <br />ANNUAL F)/E and REPORT REQUEST <br />Washington County <br />~M-2001-012 <br />Shook Gravel Pit 1 <br />May 31, 2007 <br />~~~y o ~ <br />bkjaton of ~?OQI <br />(_ Mining anir 3a efy on <br />$$688.00 (Due on or before your anniversary date) <br />Washington <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_ <br />operator-shall submit the annual fee, a_report_and mag~howing 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 vour 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. resort, and <br />associated man. If no new disturbances or reclamation have occurred durinti the previous year and no <br />new chanties to the previous year's man are necessary. then no new man is required, provided that the <br />Oaerator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Jesse Stackhouse <br />Permittee Name: Washington County <br />Address: 150 Ash <br />Akron, CO 80720 <br />t.1 R c~ Cu,G-~r ~~Q .~~ ~ <br />-.vim ~~ W-2 .h-s-uXgty <br />„~ ~ 00 t? ~ 'j.)CJ <br />_~-~-.-r.-- _~~ <br />Phone Number: (970) 345-2701 <br />Fax Number: (970) 345-2702 <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 <br />enclosed. /~. <br />/l o-,s-~ / G~-zrv~-m-,,-, <br />gnature o orporate Officer, Owner, or Designee <br />2 ~- ~O O <br />Date <br />M:~PERMINNASTERDOCUMENTSVN-AF-04 <br />