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PC k- ,(ZP'T <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Sky Ute Sand & Gravel, LLC 'Plu <br />PERMIT NO.: M-2003-037 ? <br />OPERATION NAME: Haldorson Sand and Gravel Mine <br />ANNIVERSARY DATE: December 16, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Montrose <br />RECEIVED <br />DEC U 7 2UUq <br />Divi"n of Reclamation, <br />Mining and Safety <br />'-91 <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 />_-r-e->lamation-aoecamplished-to-date-and-during-the-preeeding-year, new-disturbances-that-are-anticipated-to-oc;car - - <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 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Kevin Hunt <br />Permittee Name <br />Address: <br />Phone Number: <br />Fax Number: <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 />Sky Ute Sand & Gravel, LLC <br />P.O. Box 3268 <br />Montrose, CO 81402 <br />(970) 249-6533 <br />Date