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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />ANNUAZ FEE and REPORT REQUEST <br />?L. . Everist, Inc. <br />',0Lohmann Sand and Gravel Mine <br /> <br />EP 2 ?008 <br />vvl":.'° Aoo and ssfzay <br />September 19, 2008 <br />$791.00 (Due on or before,your anniversary date) <br />Weld <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 />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 <br />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 & Fee <br />requirement is not met until we have received the following components: fee, report, and associated may. If no <br />new disturbances or reclamation have occurred during the previous year and no new changes to the previous <br />year's map are necessary, then no new map is required, provided that the Operator shall state this in the Annual <br />Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary changes: <br />Permittee Contact: ayer Shults <br />Permittee Name: L.G. Eve k, Inc. <br />Address: 7321 E. 88th Ave., Ste 200 <br />Henderson, CO 80640 <br />Phone Number: <br />Fax Number: <br />(303) 287-4656 <br />(303) 289-1348 <br />If you have additional comments and/or information that should be provided to the Division, please provide it below or <br />attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />A l <br />re o Corporate Of ,56r, 6-11r, or 11esi e <br />Date