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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNiJAL FEE DUE: <br />COUNTY: <br />~ ; ~ /~ <br />AL FEE and PORT REQUEST <br />/Donald R Hart <br />~I-1980-049 <br />Mott Gravel Pit <br />February 18, 2008 <br />$$323.00 (Due on or before your anniversary date) <br />Montrose <br />RE~WwA~D <br />1~EB 0 6 2008 <br />®ivision of ~ectamation, <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 />reclai;lat-;om acco:nplshed to-.gate-and during tl~.s-p:ecea.::~-y:,ar; new-3istarb~. ~: s that are z ticipated, 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 durinL the previous year and no new chanEes 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: Donald R. Hart <br />Permittee Name: Donald R Hart <br />Address: 3500 Clear Fork Rd. <br />Crawford, CO 81415 <br />Phone Number: (970) 921-5299 <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 gcritten report and map. Annual Report instructions are enclosed. <br />Officer, Owner, or <br />Date <br />