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s <br />a T <br />ANNUAL FEE and REPORT REOUEST „??/ JUL <br />2- 1 <br />PERMITTEE NAME: Grand County Department of Road & Bridge' 200$ <br />iI / Division of ?Eciznation, <br />PERMIT NO.: M'-2006-029 Mining and Safety t-'o <br />OPERATION NAME: South Fork Gravel Pit (aka Williams Fork) <br />ANNIVERSARY DATE: August 28, 2008 <br />ANNUAL FEE DUE: 5323.00 (Due on or before your anniversary date) <br />COUNTY: Grand <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 shall <br />11 <br />submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation <br />accomplished to date and during the_preceding year, new disturbances that are anticipated to occur during the upcoming <br />year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the <br />date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report man to this form. The Annual Report & Fee <br />requirement is not met until we haven received the following components: fee, report, and associated map. If no <br />Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary changes: <br />Permittee Contact: Bill Clark <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Grand County <br />of Road & Bridge <br />P.O. Box 9 <br />Granby, CO 80,446 <br />(9'70)48-7-- ? <br />(970) 887-3168 <br />`''/ 1) P R 2- 217- 5 <br />If you have additional comments and/or, information that should be provided to the Division, please provide it below or <br />11 <br />attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />01 <br />of Corporate Officer, Owner, or Designee <br />Date