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<br />RECEIVE® <br />PERMTITEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />C & J Gravel Products, Inc. <br />M-1980-146 <br />Montoya Pit <br />May 1, 2004 <br />$688.00 (Due on or before your anniversary date) <br />La Plata <br />MAY 0 3 2004 <br />0(vlelon ai Minersls & 6eolepY <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-tc occur- <br />-- ' - iltiring 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 y~rr revised written annual report and annnal re un rt 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: Jahn Gilleland <br />Permittee Name: C & J Gravel Products, Inc. <br />Address: 27661 U.S. Hwy. 160 E. <br />Durango, CO 81301 <br />Phone Number: (970) 385-4112 <br />Fax Number: (970) 385-5014 <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 />e of Corporate fficer, Owner, or Designee <br />/~ /~L~ <br />Date <br />