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-1Z~- 5 <br /> ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: r/King Mountain Gravel, LLC RECEIVED <br />PERMIT NO.: ~M-1978-314 ~~~ ~ () X006 <br />OPERATION NAME: King Mountain Sand & Gravel Mine , <br />i"~+ vision of Reclamation, <br /> Mining and Safety <br />ANNNERSARY DATE: November 22, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Routt <br />I ~~~ <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; new disturbance"s that'are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates far 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 Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durin¢ the previous Year and no new changes to <br />the previous year's man are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Reuort. 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 />Pennittee Contact: Kirk J. Eber] <br />Permittee Name: King Mountain Gravel, LLC <br />Address: 7276 W. Mansfield Ave. <br />Lakewood, CO 80235 <br />S~YY~.G <br />Phone Number: (303) 988-6286 <br />Fax Number: (303) 986-2771 <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below gaattach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of C orate Officer, Owner, or Designee <br />11-/H-Dc <br />Date <br />