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ANNUAL FEE and REPORT REQUEST <br />PERMITI'EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Grand Junction Concrete Pipe Co. <br />M-1980-080 <br />Una Pit <br />July 24, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Ga~eld <br />~~ <br />RECEI!/ED <br />JUL 1 9 2002 <br />Division of Minerals and Geology <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 yeaz, 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 vaur 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: Edward J. Settle <br />Permittee Name: Grand Junction Concrete Pipe Co. <br />Address: P.O. Box 1849 <br />Grand Junction, CO 81502 <br />Phone Number: (970) 243-4604 <br />Fax Number: (970) 243-6703 <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 />Signature o orporate Officer or Owner <br />/'?~ 20 c~~ <br />Date <br />M:~PERMITMASTERD000MENTSIM-AF-01 <br />