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l7~ ? "r <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ~ Delta County <br />PERMIT NO.: ~M-1979-140 <br />OPERATION NAME: Lemoine Gravel Pit <br />ANNIVERSARY DATE: February 16, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUN"I'Y: Delta <br />~~ <br />RECEIVED <br />-JAN 2 6 2001 <br />Division of Reaamation, <br />~, Mining and Safety <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 map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year; new disturbances that aze anticipated fo- ' <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 yeaz, if any. <br />Please attach vour revised written annual report and annual report man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, resort, and <br />associated map. If no new disturbances or reclamation have occurred durinti the previous year and no <br />new chanties to the previous year's maa are necessary, then no new mau is required, arovided 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 permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />County Engineer <br />Delta County <br />501 Palmer St., Ste. 227 <br />Delta, CO 81416 <br />(970) 874-2100 <br />(970)874-2114 <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 aze <br />enclosed. <br />~ ~~ <br />mature f Corporate Officer, Owner, or Designee <br />Date <br />M:~PERMI'MIASTERDOCUMENTSU-f-Ar-04 <br />