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Ar- +_ C?6-- <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 />t% <br />Rio Grande County / <br />M-1978-071 c? <br />Del Norte Gravel Pit <br />November 25, 2009 <br />$791.00 (Due on or before your anniversary date) <br />Rio Grande <br />HIV 1 2009 <br />Mirt!rg .a 3a; eiy <br />According L.C.R.S. 34-32.5-116 or_C.R.S. 34-32-116, each ,year, on the anniversary_date_ofthe_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 may 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 />operator sball 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: Patrick Sullivan <br />Permittee Name: Rio Grande County <br />Address: 168 N. Washington <br />Monte Vista, CO 81144 <br />Phone Number: (719) 852-4781 <br />Fax Number: (719) 852-0305 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below ac it to this form along with your written report and map. Annual Report instructions are <br />en se?1 <br />Signature of Corporate Officer, Owner, or Designee <br />1-24 NOV 05 <br />Date <br />WWN" <br />V/ NOV 16 2009 <br />1?y Divir?vn of Recla+'nsrtioR, <br />Mining and Safety <br />M:IPERMIIIMASTERDOCUMENTS\M-AF-04