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j A <br />per <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Schmalz Construction Ltd <br />/ <br />PERMIT NO.: / M-1984-069 JUN 112009 <br />OPERATION NAME: Schmalz Const Pit v "*V Rnd Safe ion <br />ANNIVERSARY DATE: July 12, 2009 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Gunnison <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 />urmg t e uupcommg year, reclamationnhat-will-be perfb-mie-d-during t e coming year; th-e dames fo`r 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 map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual 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 Schmalz <br />Permittee Name: Schmalz Construction Ltd <br />Address: P.O. Box 1105 <br />720 S. 8th St. <br />Gunnison, CO 81230 <br />Phone Number: (970) 641-2014 <br />Fax Number: (970) 641-4231 <br />If you ha additional comments and/or information that should be provided to the Division, please provide it <br />below attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />?Sioature of Corporate O icer, Owner, or Design <br />o? <br />Date