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ANNUAL FEE and REPORT 12EOUEST <br /> OGI"ea\/t=11 <br />PERMITTEE NAME: Dolores County AUG 2 3 2001 <br />PERMIT NO.: M-1984-155 givision of r2eaama,wn, <br />Mining grad Safely <br />OPERATION NAME: Bartley Gravel Pit <br />ANNNERSARY DATE: September 27, 2007 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Dolores <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 <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual resort map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, resort, and <br />associated map. If no new disturbances or reclamation have occurred during the previous vear and no <br />new chances to the previous year's man are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Tim Huskey <br />Permittee Name: Dolores County <br />Address: P.O. Box 608 <br />Dove Creek, CO 81324 <br />Phone Number: (970) 677-2328 <br />Fax Number: (970) 677-3759 <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 <br />enclosed. <br />gnature of Corporate O rcer, Owner, or Designee <br />/SQ-G7-O'7 <br />Date <br />M:~PERMITNIASTERDOCUMENTS4M-AF-04 <br />