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,? L <br />potl?' A2? <br />, "/ qqwc <br />'7 w <br />EST iAlAY 12 2009 <br />Divieim of t-?edamation, <br />b 0 Mirt+ig and Safety <br />OPERATION NAME: Halde Pit <br />ANNIVERSARY DATE: June 18, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Kit Carson <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-per-formed-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 uire'ment i"s-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: Kerry Hald <br />Permittee Name: Halde San & Gr vel, Inc. <br />Address: 46321 US Highway 24 <br />Burlington, CO 80807 <br />Phone Number: (719) 346-0352 <br />Fax Number: (719) 346-8945 <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 of Corporate Officer, Owner, or Designee <br />Date <br />PERMITTEE NAME: #Halde Sand & Gravel, Inc. <br />PERMIT NO.: 144-2008-014