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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />.~~ ~~~~r <br />ANNUAL FEE and REPORT REQUEST <br />j~ouisiana Land and Gravel Company, LLC <br />~M-2000-049 <br />Angie Pit <br />April 9, 2008 <br />u~~/e <br />~A ~~~~,. <br />O,•~s. <br />~~49an ~c~4r 08 <br />ms,`~~~~ ~~r! <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Montrose <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 />_during_the~upcoming.year,_reclamation,that will. be :performed- during-the _com_i_ngyear.,_the=dates-for-th_ e_b_eginning _ _- <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 />mau. If-no new disturbances or reclamation have occurred durin the previous year 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 />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Michael A. DeJohn <br />Permittee Name: Louisiana Land and Gravel Company, LLC <br />Address: P.O. Box 8419 <br />Clinton, LA 70722 <br />Phone Number: (225) 683-3358 <br />Fax Number: (225) 683-3802 <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 of Corpora O icer, Owner, or Designee <br />~~ <br />Date <br />