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AF * P' <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Mesa County Public Works KIRCEN) E® <br />PERMIT NO.: M-1983-216 ? HAY <br />3 0 2000 <br />OPERATION NAME: Lumsden Canyon Pit Division of Reclamation, V?11- <br />ANNIVERSARY DATE: June 11, 2008 Mining and Safety <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Mesa <br />Accordin tg o 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 vour 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 during the previous year and no <br />new chanLyes to the previous vear's map are necessarv, 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: Stacy Mascarenas <br />Per nittee Name: Mesa County Public Works <br />Address: P.O. Box 20000-502J - <br /> <br />j). o ' &DX X000- 5D 1 f> <br />Grand Junction, CO 81502 <br />Phone Number: (970) 244-1787 <br />Fax Number: (970) 255-7171 <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 />enclosed. <br />ate Officer, Owner, or Designee0 <br />Signature of Co IL9 <br />Date <br />M:\PERMITVv ASTERDOCUMENTS\M-AF-04