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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNLIAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Fremont Couuty <br />~M-1984-117 <br />Fremont Gravel Pit <br />January 20, 2007 <br />~i~is oAN ~ ~Z~~I <br />Mining aRd ga e~y oR, <br />$$281.00 (Due on or before your anniversary date) <br />Fremont <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 <br />operator sha[I submit't~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 aze anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the <br />beginning 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 map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, reuort, and <br />associated man. If go new disturbances or reclamation have occurred durine the arevious vear and no <br />new chanties to the previous year's map are necessary, then no new maa 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 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: Paul Garrett <br />Permittee Name: Fremont County <br />Address: 615 Macon Ave 100 <br />#105 <br />Canon City, CO 81212 <br />Phone Number: (303) 942-4234 <br />Fax Number: <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 aze <br />enclosed. <br />Signature of Corporate Office Owner, or Designee <br />~/.~oz <br />Date <br />M:IPERM7TMASTERD000MENf51M-AF-04 <br />