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-~~ ~ R~-r <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNiJAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Solberg Gravel LLC <br />M-1981-044 <br />Solberg Pit <br />Apri17, 2008 <br />~~~~~~~® <br />R o7 2ooa ~ <br />AP tion, <br />Division of Reclama <br />Mining and SafiefiJ <br />$$791.00 (Due on or before your anniversary date) <br />El Paso <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 />-- -=-r-eclamation_accompli:;h~d_t~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; t-he dates for~e~GGegnriirig~`~-- - <br />ofactive operations, a:nd 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 changes to <br />the previous year's neap 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: E~ob Solberg <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Solberg Gravel LLC <br />13745 Garrett Rd <br />Peyton, CO 80831 <br />('119) 683-3198 <br />('] 19) 683-4373 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it t this form along with your written report and map. Annual Report instructions are enclosed. <br />~~- it~r rye' S .yips ~ to rn G <br />Signature of Corporate: Officer, Owner, or Designee <br />y/i/dg <br />Date <br />