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Mac <br />PERMITTEE NAME <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANN A � f <br />ALEE an &01 T REQUEST <br />fi Io gan Sand & Gravel Inc <br />t�VI -1977 -094 <br />Westhoff Pit <br />December 20, 2009 <br />� "COVED <br />®EC 2 11009 <br />R <br />® { fl 9f te! <br />Mifl 4R U . <br />$$791.00 (Due on or before your anniversary date) <br />Morgan <br />61 <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 accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />- - - -- dur-ina the -- "coming - year,- reclamation -that wLill -ber performed .duringAhe..coming-year, the_ dates_f.cv --t,he_beginn.in <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual repo map to this fo rm. 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 yea and no new chan to <br />the pre vious year's map are necessary, then no new map is required, provided that the Oper ator 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: Greg Westhoff <br />Permittee Name: Morgan Sand & Gravel Inc <br />Address: 21215 Hwy No 52 <br />P.O. Box 1443 <br />Fort Morgan, CO 80701 <br />Phone Number: (970) 867 -8074 <br />Fax Number: (970) 867 -3774 <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 />Signatur f Corporate Offic wner, or Designee <br />Date <br />