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~~~~ ~ <br />ANNUAL. FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Jackson County ~~ <br />M-1977-472 <br />BLM East Gravel Pit <br />January 25, 2008 <br />REC~iVED <br />FEB 0 6 2008 <br />Division or rceclamation, <br />Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Jackson <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. shall_submit.the. 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 are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred Burins the previous year and no <br />new chances to the previous year's map are necessary, then no new map is reauired, 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: ~~~~( ~~~'~~ cJ. <br />Permittee Name: Jackson County <br />Address: P.O. Box 488 <br />188 Grant St. <br />.Walden, CO 80480 <br />Phone Number: (970) 723-4481 <br />Fax Number: (970) 723-8437 <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 <br />enclos <br />Signa re of rporate Officer, Owner, or Designee <br />i.- ~s -o g <br />Date <br />M: ~PERMITU~IASTERDOCUMENTSVvi-AF-04 <br />l~, ~ ~ ~ ~ ~„ nom. ~' c~ E <br />