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- A? <br />RECEIVED <br />i <br />ANNUA FEL and RE ORT REQUEST dUL 2 U 2009 <br />Diy <br />PERMITTEE NAME: Sanborn Sand and Gravel/dba Golden Cross Aggrega <br />ejon of Reclamation, <br />mmg and Safety <br />V PERMIT NO.: M-1984-094 <br />OPERATION NAME: Gloria Z Mine <br />ANNIVERSARY DATE: July 17, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Park <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_suhm.it_ the_annuaLfee,_a__report and -map-5 owin the extent of current disturbances to affected land, <br />- - - -_,f - <br />reclamation accomplished to date and during the preceding year,- new disturbances-that-are-anticipated-to-o-ccur <br />-during-tlre 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: Richard G. Pfister <br />Permittee Name: Sanborn Sand and Gravel/dba Golden Cross Aggregate <br />Address: 158 Glenwood Dr. <br />Metairie, LA 70005-3912 <br />Phone Number: (504) 834-8849 <br />Fax Number: <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, caner, or Designee <br />??? z, ?oD9 <br />Date