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Il <br />ANNUAL FEE andRT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />M eese Contracting <br />A- 1996 -050 <br />Reese -Logan Sand & Gravel Pit <br />November 25, 2009 <br />$$323.00 (Due on or before your anniversary date) <br />Logan <br />CW® <br />N OV 4 4 2009 <br />Div*jen of ReclaMOOR <br />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 />reclamation acco mplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation thaw `ill - b - c - performed- during- the - cem.ing year Ahe_dates foT-the beg <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annu report and annual report map to this form. The Annual Deport <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 vear's map 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: Galen Reese <br />i1Jn) A) <br />Permittee Name: Reese Contracting <br />Address: P.O. Box 105 <br />Atwood, CO 80722 <br />Phone Number: (970) 522 -0867 1 Z T11�~ii � <br />Fax Number: (970) 522 -0867 ,mac, <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 />Date <br />