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<br />~ ANNiiAi, FEE, and REPORT RF.OiTFST <br />PERMITTEE NAME: / Valle Escondido <br />PERMIT NO.: ~M-1991-133 <br />OPERATION NAME: Valdez Gravel Mine <br />ANNNERSARY DATE: April 20, 2006 <br />ANNUAL FEE DUE: $550.00 (Due on or before your anniversary date) <br />COUNTY: Conejos <br />'~~1=CEIVED <br />v ~ 101006 <br />1t7ivi8ion of Minerehand 6001pgy <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 showine the extent of~urrent_di~YUrizances to affected_]and, _ <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 ynnr revised written annual rFmnrt and annual rennrt main to this form. Please note that an <br />adequately labeled map that clearly 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: Demetrio Valdez <br />Permittee Name: Valle Escondido <br />Address: P.O. Box 84 <br />Conejos, CO 81129 <br />Phone Number: (719) 376-5873 <br />Fax Number: (719) 376-2451 (T ~ ~ ~~ 7~i - ~~ S ~ ~ <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, O , or Designee <br />Date ~ -~ <br />