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~~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />y <br />AN ~ ~ SEE and REPORT REQUEST <br />'Meeker Sand and Gravel, Inc <br />~I-1976-038 <br />Meeker Pit <br />July 25, 20077 ~I ~~ asafejy°n• <br />$$658:60 (Due on or before your anniversary date) <br />Rio Blanco <br />~ <br />~s%° ` 2'~200~ <br />n of <br />Mining an ecta?ati <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; areport-and-map- showing the-extent ~of-cun•ent-disturbances-to affected-land- ' -- <br />reclamation accomplished to date and during the preceding year, new 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 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 />maa. If no_new disturbances or reclamation have occurred during the previous year and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled m p t!z t clearly delineate 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: Joe P. Conrado <br /> <br />Permittee Name: Ieeker Sand and Gravel, Inc <br />Address: P.O. Box 1550 <br /> Meeker, CO 81641 <br />Phone Number: (970) 878-3671 <br />Fax Number: (970) 878-5751 <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 />S' lure of Corporate Officer, Owner, or Designee <br />~/z /o~ <br />Date <br />