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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUL FEE?anUPORT REQUEST <br />Leone Sand and Gravel LLC <br />?/M-2006-085 <br />Leone Gravel Pit #2 <br />April 25, 2009 <br /> <br />V-/A PR S 2 C 0 9 <br />T? n;nn <br />$$791.00 (Due on or before your anniversary date) <br />Las Animas <br /> <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 wiIl`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 changes to <br />the previous year's map 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: Frank Leone, Jr <br />?'?i4'A V r_ eoyi e <br />Permittee Name: Leone Sand and Gravel LLC L-op-onp ,5411,0 L LC <br />Address: 502 S. Walnut St. 4: Tun E 6s -VAi )t Sf, <br />--Trinidad, CO 81082 - -- ,? j A!? ? '2?10 T Z - - <br />Phone Number: (719) 846-4170 f - $"?-/ (p -q l'70 <br />Fax Number: (719) 846-0606 `7I g4 5 ?® 4 0 <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 />S eK q-T1' <br />Signature of Corporate Officer, Owner, or Designee <br />r <br />Date