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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ f ~PPi <br />ANNUAL FEE and REPORT REpUEST <br />ylCross Mountain Ranch Ltd. Partnership <br />~I-1979-102 <br />Kagie Gravel Pit <br />June 21, 2007 <br />$$281.00 (Due on or before your anniversary date) <br />Routt <br />,~ <br />. -, r".~ <br />~tP•,r <br />a _ ;,~;i <br />Dil~.~ -- <br />~:J~L,n. ~-iron, <br />~ e; ,;. Sc~:.iy <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, hew disturbances that are anticipated to 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 reuort and annual report moo to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, reuort, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the previous year's moo are necessary, then no new moo is required, provided that the Ouerator 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 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: Phil-6eerge- <br /> <br />Permittee Name: Cross Mountain Ranch Ltd. Partnership <br />Address: P.O. Box 897 <br />Craig, CO 81626-0897 <br />Phone Number: (970) 824-2803 <br />Fax Number: `1'-l U - `6 2~-I - 10 ~6 <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 aze enclosed. <br />t~.f'Y <br />Signature f Corporate Officer, Owner, or Designee <br />5~z i f y~ <br />Date <br />