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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL tE and REPOR REQUEST <br />rimer County <br />M- 1985 -135 <br />Horton Gravel Pit <br />January 31, 2010 <br />r Al <br />c <br />DEC 0 <br />15 2009 <br />Division or Reclamation, <br />j,, Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Larimer <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 <br />operator shalt 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 map 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 />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall 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: Dennis C. Morrison <br />Permittee Name <br />Address: <br />Larimer County <br />P.O. Box 1190 <br />Fort Collins, CO 80522 <br />Phone Number: (970) 498 -5652 <br />Fax Number: (970) 498 -5678 <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 <br />d. <br />Signat ��f Corporate O cer, Owner, or Designee <br />Date <br />M: TERMITWASTERDOC UMENTSW -AF -04 <br />