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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />Jackson County <br />M-1978-266 <br />Riley Gravel Pit <br />August 15, 2008 <br />$791.00 (Due on or before your anniversary date) <br />Jackson <br />RECIEPIVED <br />SEP 0 5 2000 c/ <br />Divisior, ut rteclamation, -rD <br />Mining and Safety and Safety <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 _mit the annual_fee, a_reporLand map showing.the_extent o£current_disturbances_to affected_land, reclamation _ _ <br />accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the <br />upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active <br />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 may. <br />If no new disturbances or reclamation have occurred durinu the previous year and no new chances to the <br />previous vear's man are necessarv. then no new map is required, provided that the Operator shall state this in <br />the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above <br />elements may suffice for a written report. <br />Division records indicate the following permittee contact <br />changes: <br />A-n? /1/orr?'s <br />Permittee Contact: -== 1 <br />Permittee Name: <br />Address <br />Phone Number: <br />Jackson County <br />P.O. Box 488 <br />188 Grant Street <br />Walden, CO 80480 <br />(970) 723-4481 <br />Please verify and make any necessary <br />t ? . a S cx <br />jt <br />\Sf Y re C_ <br />CST ? 6?) <br />Fax Number: (970) 723-8437 <br />If you have additional comments and/or information that should be provided to the Division, please provide it below <br />or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature o rporate Offic , Owner, or Designee <br />Date <br />M:\PERMIT\MASTERDOCUMENTS\M-AF-04