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<br />j. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Elam Construction, Inc. <br />M-1980-176-R <br />19 Road Gravel Pit <br />February 19,2002 <br />$688.00 (Due on or before your anniversary date) <br />Mesa <br />RECEIVE: <br />FEB Z 0 202 <br />DiuisionotMfietelttanT' -r <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 16, 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 />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 [he 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 report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact:. Thomas A. Logue <br />Permittee Name: Elam Construction, Inc. <br />Address: 1225 S. 7th St. <br />Grand Junction, CO 8150] <br />Phone Number: (970) 242-5370 <br />Fax Number: (970) 24~-7716 <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 />v~ <br />Signature o rAeewer <br />Avfho, A9c/+f <br />oa/~e~o 2 - <br />Date <br />M:~PERMITNIASTERD000M ENTSVvI-AF-01 <br />