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AP ? 0 <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Jackson County / <br />PERMIT NO.: M-1977-472 1/ <br />OPERATION NAME: BLM East Gravel Pit <br />ANNIVERSARY DATE: January 25, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Jackson <br />i <br />RE -ivF <br />JAN 16 2009; ? <br />Dlvioion or Reoiemat ian, <br />Minim and fafaty <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 submit the annual fee, 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 your revised written annual report and annual report map 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 may are necessary, then no new map 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 since fora written report.__ _- <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />)4 d <br />Permittee Contact: /? <br />y/Vorri,5 <br />Permittee Name: Jackson County <br />Address: P.O. Box 488 <br />188 Grant St. <br />Walden, CO 80480 <br />• O (0 1, <br />v?l h (AfW 5 J-/ - b 4,0,A; J <br />Phone Number: (970) 723-4481 <br />Fax Number: (970) 723-8437 <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 />enclosed. <br />Signatu of Corporate Officer, Owner, or Designee <br />j- 9 -0!j <br />Date <br />M:\PERMITI"TERDOCUMENTS\M-AF-04