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<br />~ yQ 1° I <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />games L. Treat <br />~-1980-041 <br />Rock Gulch Gravel Pit <br />Apri13, 2007 <br />$$281.00 (Due on or before your anniversary date) <br />Chaffee <br />-MAR z s zoos <br />©ivL:ic•. ~,- <br />fuJlgb, xi nV~OgO, <br />,~ y ~r;4.S.,irtY <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 />_ reclaination~accomplished to_date and during the preceding year, ne_w 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 ma~to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />maa. If no new disturbances or reclamation have occurred durin~the~revious year and no new changes to <br />the previous year's maa are necessary, then no new moo is required, urovided 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 [he following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: James L. Treat <br />Permittee Name: James L. Treat <br />Address: 225 "G" St. <br />Salida, CO 81201 <br />Phone Number: (719) 539-2215 <br />Fax Number: (719) 539-2588 <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 />e <br />Date <br />