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/i <br />~~~ / <br />~ ~~ <br />ANNUAL FEE and REPORT REQUEST ~~~~,®~~ <br />PERMITTEE NAME: ~ ri County Gravel / ~o~ 2 9 200 <br />PERMIT NO.: M-1977-205 vision of Reclamation <br />Mining and Safety <br />OPERATION NAME: Tri-County Gravel <br />ANNIVERSARY DATE: November 29, 2007 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Delta <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 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_heginning~, -! <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 durinE 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: Richard E. Curry <br />Permittee Name: Tri County Gravel <br />Address: P.O. Box 566 <br />Hotchkiss, CO 81419 - _ _ . __ _ _ _ _ _ __ _ _ _ - _ _ . <br />Phone Number: (970) 872-3545 <br />Fax Number: (970) 872-3792 <br />If you have additional comments and/or information that should be provided Ito .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 />~~ <br />Signature of Corporat icer, Owner, or Designee <br />Date <br />