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-;~ =~~ <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY:- <br />~"- / <br />ANNUAL FEE and REPORT REQUEST <br />oa ~°`~ <br />`~ Leone Sand and Gravel LLC I~ ;~ ~° `r i~ Pte- <br />M-199a-ooh / FEB 217.ap7 <br />Emerald Vista Estate <br />Dlvis+on of F;~,' :,~i'tlefl, <br />March 11, 2007 Mining cr~r: Sa7dly <br />$$281.00 (Due on or before your anniversary date) <br />Las Animas <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 />reclamafion accomplished to date and during the preceding yeaz, new disturbances that aze anficipated to occur <br />during the upcoming yeaz, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operatons, and the date acfive operations ceased for the year, if any. <br />Please attach your 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 during the previous year and no new chances to <br />the previous year's map are necessary, then no new map is reanired, provided that the Operator shaII 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 permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Frank L. Leone Jr <br />r~ ~~- -~. <br />Permittee Name: Leone Sand and Gravel LLC <br />Address: 502 S. Walnut Street <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-4170 <br />Fax Number: (719) 845-0605 <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 />2 - /la.~ <br />Date <br />