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' - " /?/o 7- V <br />?ALFE1 and REPORT REQUEST F.C <br />AN _ <br />PERM ITTEE NAME: P Lee Roy and Marlene J Rothe //JAN 13 ZOAO <br />PERMIT NO.: VIKA-1995-017 Division of Reclamation, <br />OPERATION NAME: Rothe Sand & Gravel Pit 40 Mining & Safety <br />ANNIVERSARY DATE: December 18, 2009 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Logan <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-accomplishedAo_date_and_d_uring the _Rreggq&g year, new disturbances that are anticipated to occur <br />^ <br />_ ?- <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 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 year'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: <br />1 ?. <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number <br />Lee Roy Rothe <br />6 <br />Lee Roy and M rlene J Rothe 624 d <br />19727 Factory St <br />Sterling, CO 80751 <br />(970) 522-2281 <br />(970) 522-2282 <br /> <br /> <br /> <br /> <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 />- La - C1 DID <br />Date