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Np- i- RP T- <br />ANNUAL FEE and REPORT RIEOUEST <br />PERMITTEE NAME: Frank Gilmore 'op <br />PERMIT NO.: M-1983-209 \. <br />OPERATION NAME: Benton Dawson Gravel <br />ANNIVERSARY DATE: July 25, 2008 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Delta <br />RECOVER <br />JUL 17 ZOGB <br />Division of Fteciamation, ? <br />Mining and Safety <br />According to C.R.S. 34-32.5-116 or C R.S. 34-32 lj6,Saqh-y <br />Far,on the_anntversary date.o£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 u comin _- ear"=reclamation that will-be performed durin -the-comin year, the-dates forthe beginning <br />g P gY g gY .-- <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 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: Frank Gilmore <br />Permittee Name: Frank Gilmore <br />Address: 5998 Sawmill Mesa Road <br />Delta, CO 81416 <br />Phone Number: (970) 874-5157 <br />Fax Number: <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 />Si re of Corporate Officer, Owner, or Designee <br />7- / y - o? <br />Date