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A~ -~(Z~~ <br /> ANNUAL FEE and REPORT REQUEST <br /> <br />PERMITTEE NAME: Canyon Sand & Gravel <br />PERMIT NO.: M-1988-057 i/ <br />OPERATION NAME: Canyon Sand & Gravel <br />ANNNERSARY DATE: August 16, 2007 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Archuleta <br /> <br />RECEIVED <br />OCT 012007~/yy <br />Division ofa d S~~ n 1/ <br />Mining <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 />_ __.~eclamation accomplished to, date_and_during_the_p;gceding year,_new disiurbances_that_aze_anti~ated 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 yaur revised written annual report and annual reuort 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 />maa. If no new disturbances or reclamation have occurred durinc the nrevious vear and no new chances to <br />the urevious year's map are necessary, then no new map is required, provided that the Oaerator shall state <br />this in the Annual Reuort. Please note that an adequately labeled map that clearly de[tneates 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 />Permittee Contact:./R~be~rt S~. jSco~tt <br />G~~o""~ <br />Permittee Name: Canyon Sand & Gravel <br />Address: P.O. Box 4362 <br />Pagosa Springs, CO 81157 <br />Phone Number: (970) 731-4707 <br />Fax Number: (970) 731-4707 <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 />Signature of Corporate Officer, Owner, or Designee <br />Date ~ ~~ <br />