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i <br />PERMITTEE NAME: <br />PERMIT NO.: <br />m- -? ? l <br />ANNUAL FEE and REPORT REQUEST <br />Neil's Excavation/ <br />M-1980-143 ../ <br />1XWU0WVm? <br />',---'OCT 2 7 2009 <br />OPERATION NAME: Texas Creek Gravel Pit DN*Wn of Reclamafiow, <br />ANNIVERSARY DATE: October 27, 2009 lv Wining and Safety <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: La Plata <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 />reciamatioiraccomplished-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 vour 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 />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 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: Bruce E. Neil <br />Permittee Name: Neil's Excavation <br />Address: 486 CR 515 <br />Ignacio, CO 81137 <br />Phone Number: (970) 884-2290 <br />Fax Number: (970) 884-1000 <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 />4 n, /,///& (9r- es/cle 4 <br />S' ature of Corporate Officer, Owner, or Designee <br />/c/ /0,7 <br />Date