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<br />,' C i- A? T <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Delta County F? P, lark 1 V k D <br />M-1978-304 ,'/??T •0 ? 209 <br />Triantos Gravel Pit v <br />Division cr Reclamation, <br />November 13, 2009 mining and Safety <br />$791.00 (Due on or before your anniversary date) <br />Delta <br />According to C.R.S. 3.4-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous _year's map are necessarv, then no new map is reauired, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Larry Record <br />Permittee Name: Delta County <br />Address: 501 Palmer St Ste 227 <br />Delta, CO 81416 <br />Phone Number: <br />Fax Number: <br />(970) 874-2100 <br />(970) 874-2114 <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 <br />enclosed. / <br />ignature of 'rporate Officer, Owner, o . Designee <br />O? Ze? ? <br />Date f <br />M:\PERMIT1NWTERDOCUMENTS\M-AF-04