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RECRIVED <br />SEP 28 2009 14, <br />?h, <br /> <br />Division of Declamation, <br />Mining and Safety =- _ "- <br />__._ -- - -- ANNIJAL-FEE a°nd -REPOR'T12E VEST <br />PERMITTEE NAME: Gary Rinderle Construction, Inc. eD ryl 1 Rqf n <br />PERMIT NO.: M-2001-088 V/0 <br />i <br />OPERATION NAME: Upland Gravel Kas tld`?-? <br />ANNIVERSARY DATE: October 17, 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 />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 may to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />man. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous vear's map are necessarv. then no new map is reauired. 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: Gary Rinderle <br />Permittee Name: Gary Rinderle Construction, Inc. <br />Address: 542 33 Rd. <br />P.O. Box 1380 <br />Clifton, CO 81520 <br />Phone Number: (970) 434-0510 <br />Fax Number: (970) 434-6510 <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, Owner, or Designee <br />?--2 <br />Date