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~~ <br />~/' / ~ .~ <br />ANNUAL FEE and PORT REQUEST ~~~ <br />~~~ <br />PERMITTEE NAME: ~~aniel J. Gaudreault and Barbara J. Gaudreault ~PF -~ ®Z~48 <br />®i le%~ or ~~ - <br />PERMIT NO.: ~jVI-2006' 081 ~Minins ~~~ Sa e1 tion, <br />OPERATION NAME: Big G Gravel Pit Y <br />ANNNERSARY DATE: Apri124, 2008 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Pueblo <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 />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />car-r~eclamattc~n-tltat-s~-b -se~ti~g-yeer~*., a°*~ F ° .~, <br />_ - __ °-tlie-upeorrrrrg-q ~ ~ ~ _ ~...~~~~~..o-l~eginrx~a --- <br />ofactive 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 />mau. 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 mau 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: Daniel J. Gaudreault <br />Permittee Name: Daniel J. Gaudreault and Barbara J. Gaudreault <br />Address: P.O. Box 69 <br />Eilizabeth, CO 80107 <br />Phone Number: (303) 436-3081 <br />Fax Number: (303) 646-1451 <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 />G~%n~ ~ <br />Signature o Corporate Officer, Owner, or Designee <br />~-I~lo~ <br />Date <br />