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%~{°l <br />ANNUAL lEE and REPORT REQUEST <br />PERMITTEE NAME: ~/~Louisiana Land and Gravel Company, LLC <br />PERMIT NO.: t/M-2000-049 <br />OPERATION NAME: Angie Pit <br />ANNIVERSARY DATE: April 9, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Montrose <br />~R 2 3 2001 <br />v~s~on of a^d Sa atY n, <br />Minln9 <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 />rg~amation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation-that willrtieperf6i`med-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 vour revised written annual report 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 />map. If no new disturbances or reclamation have occurred durinc the arevious veer and no new chances to <br />the previous year's man are necessary. then no new man is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Michael A. DeJohn <br />Permittee Name: Louisiana Land and Gravel Company, LLC <br />Address: P.O. Box 8419 <br />Clinton, LA 70722 <br />Phone Number: (225) 683-3358 <br />Fax Number: (225) 683-3802 <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 o or orate Officer, Owner, or Designee <br />~~ <br />Date <br />