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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~. fir/ <br />ANNUAL FEE and REPORT REQUEST <br />~ Rio Blanco County <br />iM-2000-037 <br />Baxter Pass Gravel Pit <br />May 10, 2007 <br />$$281.00 (Due on or before your anniversary date) <br />Rio Blanco <br />r~ -, <br />Divisin ~ ' , ~t1u~ <br />J <br />`~°nrn9 aro Saict iroq. <br />Y <br />According to l;.R.S- 34-32.5-116 or C:R:S. 34-32-116, each-yeas;-on-the-anniversarq-du~e-of-th~-periniY;-~n - <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated man. If no new disturbances or reclamation have occurred durine the previous year and no <br />new chances to the previous year's man are necessary, then no new man is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: David P. Morlan <br />Permittee Name: Rio Blanco County <br />Address: 570 2nd St. <br />Phone Number: <br />Fax Number: <br />Meeker, CO 81641 <br />(970)878-9590 <br />(970) 878-3396 <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 <br />enclosed <br />~~ - <br />~S~nature of Corpofate~Officer, Owner, or Designee <br />s ~~ 7 <br />vate <br />M:IPERMITNIASTERDOCUMENTSVN-AF-04 <br />