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ANNUAL FEE and REPORT REQUEST <br />Grand Junction Pipe & Supply Co. <br />M-1998-105 <br />Delta Paving Gravel Pit <br />August 6, 2002 <br />AUG 0 5 2002 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />RECEIVED <br />Division of Minerals and Geology , <br />$688.00 (Due on or before your anniversary date) <br />Delta <br />According [o 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 aze anticipated [o 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 your revised written annual report and annual report 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: Edwazd J. Settle <br />Permittee Name: Grand Junction Pipe & Supply Co. <br />Address: P.O. Box 1849 <br />Phone Number: <br />- --Fax Number: - <br />Grand Junction, CO 81502 <br />(970)243-4604 <br />(970)243-6703 _ _ _- _ _ <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 instmctions are enclosed. <br />~~ - <br />Signature o Corporate Officer or Owner <br />G'- l- 2 do''- <br />Date <br />M:~PERMITMASTERD000MENTSVN-AF-01 <br />