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/~/J ~ P <br />ANNiJAL FE and REPORT REQUEST <br />PERMPI'TEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/ F/lorence Sand & Gravel <br />/1vi-1992-051 <br />Florence Sand & Gravel Pit <br />August 11, 2007 <br />~' <br />~UL 2 3 2007 <br />.-~mM n ng and Safety n <br />$791.00 (Due on or before your anniversary date) <br />Fremont <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 />' -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 annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous vear and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note tha[ an adequately labeled map that clearly delineates and includes the <br />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: Delmer R. Rodarmel <br />Permittee Name: Florence Sand & Gravel t7/7°tlc( _~4rto/ ' ~izr~L ~ LG <br />Address: 799 5th St. <br />Penrose, CO 81240 <br />Phone Number: (719) 784-9255 <br />Fax Number: (~ft9>'/Sy-3~y1 ~/~ - ~fS/~_ 32y/ <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 />At L~~d /l'1 l/lad' . iJ/ <br />Signature of Corporate Officer, Owner, or esignee <br />Q~' aid "OrJ <br />Date <br />