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y0e <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />T <br />ANNUAL FEE ind PORT REQUEST <br />-/King Mountain Gravel, LLC <br />/M-1978-314 <br />King Mountain Sand & Gravel Mine <br />November 22, 2007 <br />$$791.00 (Due on or before your anniversary date) <br />Routt <br /> <br />AOV 2 3 2007 <br />®iv ion of Reclamation, <br />Mining and Safety <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 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_y_ear,_new disturbance hat 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 report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous 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: Kirk J. Eberl <br />Permittee Name: King Mountain Gravel, LLC <br />Address: 7276 W. Mansfield Ave. <br />Lakewood, CO 80235 <br />Phone Number: (303) 988-6286 <br />Fax Number: (303) 986-2771 <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 />Signature o Corporate Officer, Owner, or Designee <br />7? -cr <br />Date