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s <br />c~ <br /> <br /> ANNUAL FEE and REPORT REQUEST <br /> Q <br /> w <br />r9 <br />PERMITTEE NAME: United Companies of Mesa County, Inc. <br /> G <br />O <br />PERMIT NO.: M-1979-075-HR tt`~ V <br />` <br />OPERATION NAME: Chambers Gravel Pit n~C! <br />~~ <br />o~u0v <br />~ <br />ANNNERSARY DATE: May 29, 2002 Ge <br />S <br />~ ao <br />`~,R a <br />F ;Y` \5 <br />a <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) ~vS:sQ~'s <br />0 <br />COUNTY: Ga~eld ~.. `~~~ <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 year, reclamation [hat will be performed during [he coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />ch vour revised written annual report and annual report map to this form. Please note that an <br />labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate [he following petTnittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Richard Johnson <br />Permittee Name: United Companies of Mesa County, Inc. <br />Address: P.O. Box 3609 <br />Grand Junction, CO 81502 <br />Phone Number: (970) 243-4900 <br />Fax Number: (970) 243-5945 <br />>f 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 />Signature of Corporate Officer or Owner <br />fW 2( Zvo2 <br />Date <br />M:~PERM ITU IASTERDOCUMENTSU1-AF-01 <br />