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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: P/1 Bear River Sand & Gravel <br />PERMIT NO.:. M-1986-040 <br />OPERATION NAME: Bear River S & G <br />ANNIVERSARY DATE: November 20, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Routt <br />WCW'VW <br />?NOV 2 0 2009 <br />91 Division of RedWSWR, <br />C: Mining and Safety <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 />- rec amation accomplislied°to- a e an durmglhe preceding year, new digtur6ances--that are an-f ciVaatecYto- 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 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 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 sufce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lester Crawford <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Bear River Sand & Gravel <br />P.O. Box 616 <br />Oak Creek, CO 80467 <br />/UO L? 9 X16 S 075- <br />Z/CC l 1ci? <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 writt n report and map. Annual Report instructions are enclosed. <br />- 45i(? E Signature of Corporate Officer, Owner, or Designee <br />Date