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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />J6 Z <br />ARS Sand & Gravel Co LLC <br />M-1980-020 <br />Braley S&G Pit No 1 <br />July 15, 2009 <br />$$791.00 (Due on or before your anniversary date) <br />Douglas <br />1 <br />RECEIVED <br />JUN 3 3 2009 <br />Division of Reclamation, <br />Mining 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 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: Roy Mayfield <br />Permittee Name: ARS Sand & Gravel Co LLC <br />Address: 8505 W. Mtn. View Ln. <br />Littleton, CO 80125 <br />Phone Number: (303) 791-7404 <br />Fax Number: (303) 791-7405 <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 />",kkL <br />Signature of Corporate Officer, Owner, or Designee <br />(, <br />Date