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14F + ?P 9- <br />ANNUAL FEE and REPORT R?iE?O' UEST <br />PERMITTEE NAME: Duckels Construction, Inc. <br />PERMIT NO.: M-1976-051 <br />OPERATION NAME: Bettger Gravel Pit <br />ANNIVERSARY DATE: May 8, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Routt <br />mclaw" <br />MAY 11 2009 <br />Divisioo of KectrmatIO", <br />Mine and Safety <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 changes to <br />the previous year's map are necessarv. 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: Fred A. Duckels <br />Permittee Name: Duckels Construction, Inc. <br />Address: 3500 Duckels Court <br />Steamboat Springs, CO 80487 <br />Phone Number: (970) 879-6072 <br />Fax Number: (970) 879-6748 <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 />Signature f Corp ate cer, O ner, or Designee <br />4 <br />Date