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5F-M <br />ANNiJAi. FF,F, and RF.PnRT RF.niTF,ST <br />PERMITTEE NAME: S & S Aggregate, Inc ~ , <br />PERMIT NO.: M-1983-159 <br />OPERATION NAME: Gleason Pit <br />ANNNERSARY DATE: January 30, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Montrose <br />v <br />~rditig to C:R°S:-332:5=1'f6 or C:It:S: 34=32=1 T6, eachyear; o'n the a`nriiversary dale of the permit, an op"erator <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 ym~r revised written anneal rennrt and anneal rennrt manrtn 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: Jim Sutherland <br />Permittee Name: S & S Aggregate, Inc <br />Address: P.O. Box 682 <br /> Nucla, CO 81424 <br />Phone Number: (970) 731-5952 <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 />~~L\~G6~Lt. t~ <br />Signature of Corporate Officer, Owner, or Designee <br />i-lSs c~CQ <br />Dale <br />