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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />M/organ Sand and Gravel <br />vM-1977-094 <br />Westhoff Pit <br />December 20, 2006 <br />h"~ ~ ~~ fl 4 2006 <br />~Divicm,~ ci ~ ~van~aion, <br />Mimny and Safety <br />$$688.00 (Due ou or before your anniversary date) <br />Morgan <br />N <br />~~~~ <br />~~/~/~ <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 />._,..»..._..~.. __ ...............__ .., ....._ ...._ ........e ..._ r..,...,.....b ~.,..., ...... ....,.,...,........., ..,»....., ,......,. .., .,,...... <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 durinti the arevious year and no new chanties to <br />the previous year's map are necessary, then no new maa is required, provided that the Operator shall state <br />this in the Annual Report. Please note that 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: ~~g Westhoff <br />~~ <br />Permittee Name: Morgan Sand and Gravel <br />Address: P.O. Box ]443 <br />Ft Morgan, CO 80701 <br />Phone Number: (970) 867-8074 <br />Fax Number: (970) 867-3774 <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 />i~ <br />Signature o orporate Officer, Ow r, or Designee <br />ANNUAL FEE and REPORTIREOUEST <br />gZ-/- Olo <br />Date <br />