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__ _. ~ <br /> <br />ANNUAL FEE and REPORT REQUEST ~i~ `! C' 9 ZQOb <br />PERMITTEE NAME: Suburbau Sand & Gravel Co. L"' ' - ' '~+. <br />PERMIT NO.: M-1979-195 RECEIVED <br />OPERATION NAME: Road Runuer Rest ,J{t,N ~ 9 20~~ <br />ANNIVERSARY DATE: January 28, 2007 <br />Division of n~u-nation, <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) Mining and Safety <br />COUNTY: Adams <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 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 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 resort and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee. report. and associated <br />maD. If no new disturbances or reclamation have occurred durine the previous year and no new chances to <br />the previous year's map are oecessarv, then no new map is required, provioed that the Operator shall state <br />this in the Annual Resort. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may cuff ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Dean H. Craft <br />Permittee Name: Suburban Sand & Gravel Co. <br />Address: 5400 Fenton St. <br />Arvada, CO 80002 <br />Phone Number: (303) 421-0720 <br />Fax Number: (303) 467-0411 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it [o this form along with your written report and map. Annual Report instructions aze enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />