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�II 999����� <br /> U <br /> ANNUAL FEE and REPORT REQUEST <br /> PERMITTEE NAME: Rio Blanco County RECEIVED <br /> PERMIT NO.: M-2000-073 JUN 14 2001 <br /> OPERATION NAME: Shults Gravel Pit Division of Minerals and Geology <br /> ANNIVERSARY DATE: June 27,2001 <br /> ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br /> COUNTY: Rio Blanco <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 map 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 your revised written annual report and annual report map to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Jerry Steele <br /> Permittee Name: Rio Blanco County <br /> Address: Box KK <br /> Meeker, CO 81641 <br /> Phone Number: (970) 878-5601 <br /> Fax Number: (970) 878-3396 <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 /> Sign re of Corp ate Officer or Owner <br /> ,fima, 2D0/ <br /> Date <br /> M''PERM ITNMSTERDOC UMENTSVl I-AF-04 1. <br /> � l <br />