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ANNUAL FEE an REPOR RE UEST <br />PERMITT$E NAME: <br />PERMTf NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ Raymond C. Petersen <br />/ M-1981-236 <br />Colorado River Ranch Gravel Pit <br />March 29, 2007 <br />~~pR np~~ <br />~Mi>njne~~.~~O~1 <br />~w.R.;,.~«ion <br />.~, ~ <br />$$688.00 (Due on or before your anniversary date) <br />Grand <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 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 untll we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durlnti the previous year and no new chanties to <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may su~ceyor a written report. ' <br />I <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Raymond C. Petersen <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Raymond C. Petersen <br />P.O. Box 832 <br />ICremmling, CO 80459 <br />(970)724-9327 <br />(970)724-9327 <br />i <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below-er~ttach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />or <br />Date <br />