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SSS <br />/ ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ~ Maverick Sand & Gravel ~ C^ r f ~'~ <br />PERMIT NO.: / M-2002-094 C l • C -. <br />OPERATION NAME: Allen Pit ~ SEC 18 ypp~ <br />ANNIVERSARY DATE: January 23, 2007 ~~ ~~ <br />'~§ <br />ANNUAL FEE DUE: $$688.00 (Due on or before yonr anniversary date) <br />COUNTY: Montrose <br />~v~. <br />rZ~~~ <br />According to C.RS. 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 are anticiQated to occw_ _ _ _ <br />during the upcoming year; reclamation that will be performed dwing 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 vour revised written annual report and annual report map to this form. The Anneal Report <br />& Fee requirement is not met until we have received the following components: fee. resort. and associated <br />IDap. If no new disturbances or reclamation have occurred durine the urevioua veer and no new chanties to <br />the previous year's maq are necessary, then no new map is required, provided that the Ocerator shall state <br />this in the Annual Recert. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may s~ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />v17~21~ ~lJ~'.OLQ~ll01,/ <br />~^ . <br />Permittee Name: Maverick Sand & Gravel ~ ~ ,L~-t-~i <br />Address: 2352 N. 7th, Unit 8 ~ ~J q ln~C~ l~ . <br />~. D - t3c~~- .'~ to8 <br />Grand Junction, CO 81501 ~ tNt_fiyp ~ ~.D ~ `~ l~ 2 <br />Phone Number: (970) 245.4104 A1~~ - a ~}q - ~ 53 3 <br />Fax Number. q "1 ~ ~ p1, ~q - 111 S $ g r [lam <br />Jf 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 yow written report and map. Annual Report instntctions are enclosed. <br />l /"` <br />S to of Corporate O cer, Owner, or Designee <br />/aZ//S/~oO( <br />Date T~ <br />v <br />