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__- -._. ~ <br /> <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Suburban Sand & Gravel Co. <br />PERMIT NO.: M-1979-195 <br />OPERATION NAME: Road Runner Rest <br />J;~~; C 9 2006 <br />M~ns:g 2 d rat~,y <br />RECEIVED <br />JAN 0 9 2007 <br />ANNIVERSARY DATE: January 28, 2007 <br />Division of Ke~~>~na[ion, <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) Mining and Safety <br />COUNTY: Adams <br />According to C.R.S. 34-32.5-116 or C,R.S. 34-32-I 16, 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 aze 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 report and annual report maa to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fea. report, and associated <br />man. If no new disturbances or reclamation have occurred durine the orecions vear and oo new chances to <br />the previousyear's map are necessary. then no new man is required, oroviued that the Operator 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 writren report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pettnittee Contact: Dean H. Crafr <br />Petmittee Name: Suburban Sand & Gravel Co. <br />Address: 5400 Fenton St. <br />Arvada, CO 80002 <br />Phone Number: (303) 421-0720 <br />Fax Number: (303) 467-0411 <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 enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />