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s~ ~ i ~ r~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~-~ ~~Pi <br />ANNTiAT. FF.F. and RF,PTTRT RF.(1TTFST <br />Base Products <br />/ M-1994-053 <br />Base Product Gravel Pit 1 <br />September 13, 2005 <br />$688.00 (Due on or before your anniversary date) <br />Montrose <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 the date active operations ceased for the year, if any. <br />Please attach your revised written anm~al rennrt and annual report main, fn this form. Please note that an <br />adequately labeled map that clearly 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: Tony F. Appelhanz <br />Pennittee Name: Base Products <br />Address: 62339 W. LaSalle Rd. <br />Montrose, CO 81401 <br />Phone Number: <br />Fax Number: <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 />~y /" ~ <br />Signatu of Corporat fficer, Owner, or Designee <br />Date <br /> <br />(970) 249-3061 <br />e <br />