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f? JF * R9r <br />ANNUAL FEE and REPORT REQUEST RECEIVEI) <br />PERMITTEE NAME: Wyatt Redi-Mix Co <br />PERMIT NO.: M-1997-039 .? '-?JUL 2 ® 2009 <br />OPERATION NAME: Williams/Illinois Gravel Pit Division of Reclamation, <br />ANNIVERSARY DATE: August 12, 2009 Mining and Safety <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Jackson <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 />.r-eclamation_accomplished-to, _date-and.dur_ing-the_preceding_year-, _new_disturbances.that_are_antiripated-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: Richard F. Wyatt <br />Permittee Name: Wyatt Redi-Mix Co <br />Address: P.O. Box 1052 <br />Walden, CO 80480 <br />Phone Number: (970) 723-4471 <br />Fax Number: (970) 723-3222 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />b=attit rm alon g w' our written report and map. Annual Report instructions are enclosed. <br />i <br />i ature of Corporate Off r, Owner, or Designee <br />Dat?T