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PERMITTEE NAME: Walsenburg Sand & Gravel Co., Inc. <br />M-1978-283 ? E® <br />PERMIT NO.: MA? <br />OPERATION NAME: Sand Arroyo 8 200,9 <br />ANNIVERSARY DATE: April 24, 2009 Division °r Neclamation <br />ining and Safety <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) M <br />COUNTY: Huerfano <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 map 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 chanLyes to <br />the Previous ear's ma are necessary, then no new ma is re wired 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: Louis Vezzani <br />Permittee Name: Walsenburg Sand & Gravel Co., Inc. <br />Address: P.O. Drawer 352 <br />Walsenburg, CO 81089 <br />Phone Number: (719) 738-1883 <br />Fax Number: (719)"738-1883 - - - 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 />Si ature of Corporate Officer, Own r, r Designee <br />Date <br />AP '?- Z,K_ <br />ANNUAL FEE and REPORT REQUEST