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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />kez"o <br />, <br />P? <br />ANNUAL FEE and REPORT L QUEST <br />/ Conejos County <br />--" M-1987-097 <br />La Florida Gravel Pit <br />August 18, 2008 <br />f JUL 2 2008 <br />Dibislor) c; i'?C <br />"nin `'i°'nution, <br />9 and Safety <br />$$323.00 (Due on or before your anniversary date) <br />Conejos <br />a/<- <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 <br />operator shall submit--the annual.fee,-,a report and map showingthe_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 your revised written annual report and annual report may to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated may. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, 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 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: Bob Lucero <br />Permittee Name: Conejos County <br />Address: P.O. Box 157 <br />Phone Number: <br />Fax Number: <br />6683 County Rd 13 <br />Conejos, CO 81129 <br />(719) 376-5772 <br />(719) 376-5661 <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 />&:Q <br />Signature of Corporate Officer, Owner, or Designee <br />- Date <br />M:\PERMIIIMASTERDOCUMENTS\M-AF-04