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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Currier Gravel Pit, Inc. <br />PERMIT NO.: M-1980-203 <br />OPERATION NAME: Currier Gravel Pit <br />ANNIVERSARY DATE: June 29, 2009 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Mesa <br /> <br /> <br />JUN 2,d <br />2009 <br />? M+en of op. <br />9 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-distur-bances-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 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: Merial I. Currier <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Currier Gravel Pit, Inc. <br />P.O. Box 27059 <br />Denver, CO 80227 <br />(303) 738-9557 <br />J0 3 73,w-- 9yYo <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 esignee <br />2 Z zo09 <br />Date