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PERM ME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />J <br />AIGAL FEE an REPORT REOUEST <br />Sky Ute Sand & Gravel, LLC <br />✓M- 2002 -094 <br />Allen Pit <br />wlt nw <br />CEO <br />P / DEC 212009 <br />9 *ie n of Recianiafion, <br />Mining and Safety <br />January 23, 2010 <br />$791.00 (Due on or before your anniversary date) <br />Montrose <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 new disturbances - that - are - anticipated - to 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 your revised written annual report and annual report map to t his 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 a nd no new change to <br />t he previous year's map are necessary, then no new may is required, provided that the O 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: David A. King <br />Permittee Name: Sky Ute Sand & Gravel, LLC <br />Address: P.O. Box 350 <br />Phone Number: <br />Fax Number: <br />Ignacio, CO 81137 <br />(970) 382 -0609 <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 Co orate Officer, Owner, or Designee <br />Dat <br />