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~~ ~ ~~ <br />ANNUAL FEE and REPORT RE VEST ~ i ®~ <br />PERMITTEE NAME. Dilleys Sand & Gravel FEe o 1/ <br />PERMIT NO.: M-1981-004 ~ 4 2~~g L~ <br />®~~ ~ ~`eCtamation, <br />OPERATION NAME: Ayers Pit ~~ and Safety <br />ANNIVERSARY DATE: February 2, 2008 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Morgan <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,-°ne"w disturb"ance§-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 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 />mau. 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: Ve <br />illey <br /> rn <br />~~~ <br />~ <br />Permittee Name: ~ <br />Dilleys Sand & Gravel <br />Address: 1914 Edmunds St. <br /> P.O. Box 125 <br /> Brush, CO 80723 <br />Phone Number: (970) 842-2810 <br />Fax Number: (970) 842-2284 <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 of Corporate Officer, O er, or Designee <br />i'- 3 /- a <br />Date <br />