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" J` 1 <br /> NNUAL FEE and REPORT REQUEST <br />A <br />PERMITTEE NAME: / <br />"Dirt Merchant, Inc. <br />PERMIT NO.: /M-2006-027 <br />OPERATION NAME: Wells Pit <br />ANNNERSARY DATE: October 5, 2007 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Delta <br />RECEIVED <br />~ ~ o ~ Zoos <br />D' ision of Reclam7tbn, <br />tilining and Safety <br />--~- According-to-C:R,S. 34-32.5-116 or C.R.S: 34-32-1-16,.each year,.on.the.anniversary_date,of the.pemut,_an operator _, ____ <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected ]and, <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 vour 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 fallowing components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous veer and no new changes to <br />the previous year's map are necessary. then no new map 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 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: Brian Wells <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Dirt Merchant, Inc. <br />638-1800 Road <br />Delta, CO 81416 <br />(970) 874-4151 <br />(970)874-8148 <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 of Corporate Officer, Owner, or Designee <br />9- z.~ 07 <br />Date <br />