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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE a PORT UEST <br />Michael G. Erker and Cynthia L. Erker <br />A-1985-200 <br />Kula Gravel Pit <br />December 18, 2008 <br />4EC 19 2000 <br />®iv"iti? war <br />$$323.00 (Due on or before your anniversary date) <br />Morgan <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 <br />_ operator shall suumirthe-annual7fee, -a- report-and=map=showing the-extent-of- current, disturbances-to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new may is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Cynthia L. Erker <br />Permittee Name: Michael G. Erker and Cynthia L. Erker <br />Address: 2550 Winding River Dr. #M3 <br />Broomfield, CO 80020 <br />Phone Number: (303) 438-5777 <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 attach it to this form along with your written report and map. Annual Report instructions are <br />Signature of CorporatebTicer, Owner, or Designee <br />Date <br />M: PERMITIMASTERDOCUMENTS\M-AF-04