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ANNUAL FEE and REPORT REQUEST <br />~, <br />PERMITTEE NAME: White River Aggregates, Inc. ~~~~~ <br />PERMIT NO.: M-1991-009 ~ ~AR .j ~ Z~Q~ / <br />OPERATION NAME: White River S & G Pit ~iwsrrr' o he., .. <br />ANNIVERSARY DA7CE: Apri117, 2008 M~n~n9 and Safety o~~ <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) V <br />COUNTY: Rio Blanco <br />According to C.R.S. 3~1-32.5-116 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 />m ._ ._. ..., ._ .~_ .. :. ~ ~~-- _ _____ - <br />rec~am`a~ion accomp is~°ie to as a and unng the preceding year, new dis r ances a are anticipa ed 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 miap are necessary, then no new map is reauired, 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 su f ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jack E. Paulson <br />Permittee Name: V6'hite River Aggregates, Inc. <br />Address: 1 ]l07 E. Victory Way <br />Craig, CO 81625 <br />Phone Number: (970) 824-3187 <br />Fax Number: (970) 824-4067 <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 Corporate Officer, Owner, or Designee <br />. ,_. <br />Date <br />