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~RP~ ~ <br />AN1~~FEE and RE/ORT REQUEST <br />PERMITTEE NAME: - ARS Sand & Gravel Co., LLC 1~~~~,! i~® <br />PERMIT NO.: ~M-1980-020 -,~UL I ~ 1 ~ <br />2001 <br />OPERATION NAME: Braley S&G Pit No 1 Division of Reclamation, <br />~ Minin 9 <br />ANNIVERSARY DATE: July 15, 2007 9 and Safet <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Douglas <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 your revised written annual report and annual revort 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 />mau. 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 mau 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 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: 3ared~l.~len <br />~D S h S'~ Y G~'~'I-©Vl <br />Permittee Name: ARS Sand & Gravel Co., LLC <br />Address: 8505 W. Mtn. View Ln. <br />Littleton, CO 80125 <br />Phone Number: (303) 791-7404 <br />Fax Number: (303) 791-7405 <br />If you have additional comments and/or infomration 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 />2_ <br />Signature of Corporate Offic er, or esignee <br />Date <br />