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~~ ~ <br />ANNUAL FEE and POR~ OUEST <br />c~_ <br />~~~~ <br />~,~y ~, , ~dr?7 <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Montezuma Couuty <br />~I-1985-031 <br />Mancos Gravel Pit <br />May 31, 2007 <br />$$688.00 (Due on or before your anniversary date) <br />Montezuma <br />Bivi^ion" ~,,,,~amation, <br />/ (lliaine and Safety <br />According to C:R_S, 34-32.5-116 or C.R.S. 34-32-11 ,each year,_or~the anniver;la>xdate ofthe peur~it~an _ <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <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 your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinc the previous year and no <br />new chances to the previous year's map are necessary, then no new map is required, provided that the <br />Ouerator 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 />Pemrittee Contact: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Lloyd Everett <br />Montezuma County <br />1680 Hwy. 145 <br />Cortez, CO 81321 <br />(970)565-8666 <br />(970)565-8252 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below,6rl attach it to this form along with your written report and map. Annual Report instructions aze <br />1 11 <br />Officer, Owner, or Designee <br />~ S ~~ ~~~ <br />Date <br />Na ~~-~a~~~y <br />~ 3~~ <br />M:IPERMI74MA57ERD000MENI'SVN-AF-04 <br />