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<br />~rnv~. ~ e.~, ~/ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Washington County <br />M-1988-032 <br />Fassler Gravel Pit <br />May 18, 2008 <br />$$323.00 (Due on or before your anniversary date) <br />Washington <br />R~C~P4/~D' / <br />APR 10 2008 V <br />®lvision o°r F~eclaanation, <br />Alining and Safety <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 durinE the previous veer and no <br />new changes to the previous year's map are necessary, then no new map is required, 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Tim Davis <br />Permittee Name: Washington County <br />Address: 150 Ash Avenue <br />Akron, CO 80720 <br />Phone Number: (970) 345-2701 <br />Fax Number: (970) 345-2702 <br />/rrl T©/~ >~ . <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 />enclo~g/ ~~ ,a/I ~ r <br />~l'gnature of Corporate ~f`ficer, Owner, or Designee <br />` l,~ `~ <br />Date <br />M:~PERMITIMASTERDOCUMENTS~IvI-AF-04 <br />