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~; ~Pi <br />ANNUAL FEE and REPORT REpUEST <br />/ Morgan County <br />~M-1978-162 <br />Harvey Green Pit <br />~lJN 0 S 2007 <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />June 29, 2007 <br />RECEIVED <br />pinysion at Keclatt~ation, <br />PAining and Safety <br />$$688.00 (Due on or before your anniversary date) <br />Morgan <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 <br />operator shall submit the annual fee, a report and reap showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous vear and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Joe B. Baltazar Dan Royle <br />Permittee Name: <br />Address: <br />Morgan County <br />17303 CR S <br />Ft Morgan, CO 80701 <br />Phone Number: (970) 542-3560 <br />Fax Number: (970) 542-3569 <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 <br />enclosed. <br />~~~~ <br />Signature of Corporate O tcer, Owner, or Designee <br />- a~-v~ <br />Date <br />M:~PERMITNIASTERD000MENTSM-AF-04 <br />