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Ap -f- 01 r <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Thomas F & Ginger L Latham ? SEP 0 <br />PERMIT NO.: M-1981-058 ZQQ?g <br />OPERATION NAME: DeBeque Gravel Pit t/ L)iv18A Ming rleciam4tion <br />9 and Safety <br />ANNIVERSARY DATE: September 7, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Mesa <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 />rectacratio.r accanlpl sh; to gate and dur i:.b-t1?c preeed?. ig-;ear; r?ew ?isr,rha.n ces _that are an±?.capated 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 may are necessary, then no new may 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: <br />Permittee Name: Thomas F & Ginger L Latham <br />Address: 69. /3® <br />ioz 'se-9 iJ ? G' O 'Y/63 O <br />Phone Number: (93}? ?,70 - ,Z 83 - S6 33 <br />Fax Number: (9-74W}6 <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 />',.? r- a-?' <br />Signature of Corporate Officer, Owner, or Designee <br />, )-/-0 <br />Date