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y -. 4 <br />~~w <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />~~ y ! / /! <br />ANNUAL FEE and REPORT REQUEST <br />/Walsenburg Sand & Gravel Co., Inc. <br />/M-1978-283 <br />Sand Arroyo <br />Apri124, 2008 <br />$$791.00 (Due on or before your anniversary date) <br />Huerfano <br />~~~~~~® <br />... . - ,~R1pQ~ <br />~ ~QR ~eG\emat~or, <br />1/ ~~v~~~N~`g aoa sa{e~`1 <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 />-- ~recla~natioii accomplished -to-date -and- during the ,receding year, r~ew disturbances that-are anticipated to occar <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 vear 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 />ivision records~rrdcate thy-folYowing~se~nittee-contact-itrformation---Please-verifq-and-make any-necessary - -- -- <br />changes: <br />Permittee Contact: Louis Vezzani <br />Permittee Name: Walsenburg Sand & Gravel Co., Inc. <br />Address: P.O. Drawer 352 <br />Walsenburg, CO 81089 <br />Phone Number: (719) 738-1883 <br />Fax Number: (719) 738-1883 <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 />/~/. !-~ <br />Signature of Corporate Office er, or Designee <br />`~ , ~ ~ <br />Date <br />