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-. <br />+ ~ r-, <br />%l ~- T ~ <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />A~I. F E and REPORT REQUEST <br />i Western Gravel, Inc. <br />~M-1992-102 <br />South D-20 Pit <br />February 24, 2008 <br />$$791.00 (Due on or before your anniversary date) <br />Montrose <br />.. <br />~D <br />FEB $ b 2008 <br />~~~~~..,~. ~.••.zeiamationD <br />l~~Nining and Safer <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 />ieclaniaton 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 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: Judy DeVincentis <br />Permittee Name: Western Gravel, Inc. <br />Address: 3001 N. Townsend Ave. <br />Montrose, CO 81401 <br />Phone Number: (970) 249-2431 <br />Fax Number: (970) 249-0590 <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 />Sig~ture o orporate Officer, Owner, or Designee <br />!/ IO <br />Date <br />