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Alp +- 12f <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: H/S Properties v CrEI® <br />PERMIT NO.: M-2007-042 -""SEP 10 2001 <br />OPERATION NAME: H/S Properties Gravel Pit / Divisian of Reclamation, <br />v <br />ANNIVERSARY DATE: September 26, 2009 Wing and Safety <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Montrose <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 />6w7- ?turbanee <br />reclamation_accflmplished_to_clate_..ancL during. the- precedng-year;--n <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 vour 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 vear's man are necessarv. 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Dave Huerkamp <br />Permittee Name <br />H/S Properties <br />Address: <br />Phone Number: <br />Fax Number: <br />50 Heinz St. <br />Delta, CO 81416 <br />(970) 874-8006 <br />(970) 874-3883 <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 />Si ature of Corporate Officer, Owner, or e i ee <br />Date