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w ? ?kv <br /> ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Dirt Merchant, Inc. J-P <br /> <br />PERMIT NO.: M-2006-027 ? <br />OPERATION NAME: Wells Pit <br />ANNIVERSARY DATE: October 5, 2008 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Delta <br />C ?, <br />rlCnv !- <br />SEP 2 9 2000 4_/ <br />Division o- i:aclamation, <br />Mining 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 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-antrcipated-to-occur- <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report may 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 vear'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: Brian Wells <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Dirt Merchant, Inc. <br />638 1800 Road <br />Delta, CO 81416 <br />(970) 874-4151 <br />(970) 874-8148 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or a ch it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />9- /®e?' <br />Date