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- 1~ <br />S_SS <br />/ ANNUAL FEE and REPORT REQUEST <br />PERMTTTEENAME: ~ Montrose County t~~~~~~0~=~ <br />PERMIT NO.: ~ M-1984-152 ~ SEP 2 5 2006 <br />OPERATION NAME: Grizzly Ridge Pit L D vision of Reclamation, <br />ANNIVERSARY DATE: September 27, 2006 Nimin9 and Safety <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Montrose <br />rn~ <br />/b /b-b,Fj <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 yeaz, reclamation that will be performed during the coming yeaz, 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. 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: <br />Permittee Name: <br />Address: <br />Brian Wilson <br />Montrose County <br />161 S. Townsend <br />Montrose, CO 81401 <br />Phone Number: (970) 252-7000 <br />Fax Number: (970) 252-7010 <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 />~ \ ~^ <br />t <br />Si of Corporate ~c caner, or Designee <br />~~~ ~d~ <br />Date <br />M:~PERMI'MrASTERDOCUMENTSUi-AF-04 <br />