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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />/Van Valkenburg Cattle Company, LLC <br />~1~I-2005-003 <br />Van Valkenburg Gravel Pit <br />May 11, 2007 <br />$$688.00 (Due on or before your anniversary date) <br />Jackson <br />M~" i.r~ <br />. ,, <br />`QpR <br />D>V~B. 2`~ZQ 7 <br />.1+rtn/~9an~sctam~ <br />Sa/~~, on, <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 dun~nQ the preceding ear, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, <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, resort, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to <br />the previous year's mau 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 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: William Van Valkenburg <br />Permittee Name: Van Valkenburg Cattle Company, LLC <br />Address: 12353 Hwy 14 <br />Walden, CO 80480 <br />Phone Number: (970) 723-4346 Q,~,l~,p~X~ J`~~J <br />Fax Number: (970) 723-4346 ~( ~ <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />GdcG~-~-n d~_ rl <br />Signature of Corporate Officer, Owner, or De gnee <br />,~ <br />atDT e <br />