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- 5~ <br />~ ANNUAL FEE and REPORT REQUEST <br />m~- <br />ia i3 ~~ <br />PERMITTEE NAME: Gary Rinderle Construction, Inc. <br />~ ~~ G ~ e~ /~ ®~ <br />PERMIT NO / <br />v M <br />2001 <br />088 <br />.: - <br />- ~~T ~ ~ 2~~6 <br />OPERATION NAME: Upland Gravel <br />ion of Reclamation, <br />i <br />i <br /> s <br />v <br />Mining and Safety <br />ANNIVERSARY DATE: October 17, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your annivers ary date) <br />COUNTY: Mesa <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 a_nnual_f~e,_a=reRO[t~nd_.map show~_the_extent_of.currentdisturbances~_to_affected-land,-~- <br />--- -reclamation accomplished'to date and during the-preceding year, new disturbances that ar`e 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 vour revised written annual report and annual resort 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 previous veer and no new chances to <br />the previous vear's map are necessarv. then no new map 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 since for a written report. <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Gary Rinderle <br />Permittee Name: Gary Rinderle Construction, Inc. <br />Address: 542 33 Rd. <br />P.O. Box 1380 <br />Clifton, CO 81520 <br />Phone Number: (970) 434-0510 <br />Fax Number: (970) 434-6510 <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 Officer, Owner, or Designee <br />Ce "~~ <br />Date <br />