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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lymk <br />ANNUA&F, add KEPORT RE QUEST <br />9'?/Gillette Sand and Gravel, Inc. <br />?M-1992-009 <br />Gillette Pit <br />RECF RIF-0 <br />4JAN 3 0 26,09 <br />Division of Reclamation, <br />Mining and Safety <br />February 9, 2009 <br />$$791.00 (Due on or before your anniversary date) <br />Teller <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 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 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 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: V. C. Pyles <br />Permittee Name: Gillette Sand and Gravel, Inc. <br />Address: 20575 Hwy 24 <br />Woodland Park, CO 80863 <br />Phone Number: (719) 687-3111 <br />Fax Number: <br />If you have add?Tonal comments and/or information that should be provided to the Division, please provide it <br />below or attach to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />lot ate aap?i. <br />Date