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<br />ss5 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />!/ ANNUAL FEE and REPORT REQUEST <br />i/ Delta County <br />~M-1978-304 <br />Triantos Gravel Pit <br />November 13, 2006 <br />v ~ .. r. <br />.,. ~... <br />i~~~ <br />:cn, <br />$688.00 (Due on or before your anniversary date) <br />Delta <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 annuaLfee,_a-report and-map showing the-extent of-current disturbances-to-af#'ected - <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, 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. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated man. If no new disturbances or reclamation have occurred during the previous vear and no <br />new chances to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes [he 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: Larry Record <br />Permittee Name: Delta County <br />Address: 501 Palmer St., Ste. 227 <br />Delta, CO 81416 <br />Phone Number: <br />Fax Number: <br />(970) 874-2100 <br />(970)874-2114 <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 fo glop 'th your written report and map. Annual Report instructions are <br />enclosed. <br />re of o ate O icer, Owner, or Designee <br />-~~~ ~ r <br />~T~~d /7 Z~2-(v <br />ate ~ <br />M:~PERMITMASTERDOCUMENTSU-I-AF-04 <br />