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?* A- (Z?(F <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Nichols Gravel Pit, L.L.P. <br />PERMIT NO.: M-1981-013 <br />OPERATION NAME: Nichols Gravel Pit <br />ANNIVERSARY DATE: October 21, 2008 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Mesa <br />RECEIVED <br />OCT 2 0 U.', Division o-,,,,. <br />_n <br />Mining and Gamy <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />-reclamation accomplished-to date and-daring-the-preceding-year,-new disturhances-that-are-anticipated-to-occur----- <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report man to this form. The Annual Report <br />& Fee requirement is not met until we have received the following componentsfee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is reauired. provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: John Nichols <br />Permittee Name: Nichols Gravel Pit, L.L.P. <br />Address: . P.O. Box 285 <br />Mesa, CO 81643 <br />Phone Number: <br />Fax Number: <br />(970) 268-5525 <br />(970) 268-5732 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />CJA,4, qVS? <br />Si re of Corporate Officer, Owner, or Designee <br />1oit5- ?$ <br />Date