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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />?- <br />A r- : k 10 1EQUEST <br />ANN&' FEE and REPORT ARichard Fryrear <br />I-1998-071 <br />Fryrear Gravel Pit <br />November 6, 2008 <br /> <br />0IK <br />ecs <br />ACT 15 2000 <br />Divisioil Of reclamation, <br />-o' ining and Safetj <br />$$791.00 (Due on or before your anniversary date) <br />Yuma <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 anticipated to occur <br />during-the-upceming y ear-; reclamation -that will-be-performed _dur_ing 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 your revised written annual report and annual report man 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 year's may 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: Richard Fryrear <br />Permittee Name: <br />Address: <br />Richard Fryrear <br />8085 CR 13 <br />Haxtun, CO 80731 <br />Phone Number: (970) 774-6551 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or at to this form a g with your written report and map. Annual Report instructions are enclosed. <br />Si 'nature of Corporat ficer, Owner, or Designee <br />Za/' Z `1 e?D <br />Date