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~~ <br /> `~ ANNUAL FEE and REPORT REpUEST <br />PERMITTEE NAME: v S & S Aggregate, Inc <br />PERMIT NO.: ~ M-1983-159 <br />OPERATION NAME: Gleason Pit <br />ANNNERSARY DATE: January 30, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Montrose <br />~- <br />~~-dT <br />,~. <br />va 1~~~ `~~~/ll~y ~ <br />M/n/q~'oN~~oo~aq, <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, 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 accom~lished_to d to a and_during the_pr.QCeding_yeaz,_nest/_disturbances_thatate_antiC• a~to.,nccur _ _ <br />during the upcoming yeaz, 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 yeaz, if any. <br />Please attach vour revised written annual resort and annual report man 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 previous vear and no new chances to <br />the arevious 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 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 />Permittee Contact Jim Sutherland <br />Permittee Name: S & S Aggregate, Inc ~ d- S 17 4 D r-? L)Q ! Q ~%1 L <br />Address: P.O. Box 682 ~~ X ~ ~ v <br />_ 11<<,l~ CO gib ~ <br />Nucla, CO 81424 <br />Phone Number: (970) 731-5952 n`l { Q f ~~11 - ~~i ~ f ~ <br />Fax Number: / ~O - ~c' I ~ - ~'II ~~ ~ <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 />~de+` <br />1~iature o~Corporate Officer, Owner, or Designee <br />Date <br />