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'(1 rr A- R P7- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />Jackson County <br />M-1977-472 <br />BLM East Gravel Pit <br />January 25, 2010 <br />RECEIVED <br />?JAN 19 2010 <br />?Divioion or Neciamation, <br />Mining and Safety <br />$791.00 (Due on or before your anniversary date) <br />Jackson <br />According._to_C.R.S. 34 32.5-116_or C.R_S.. 34-32Jthe-anniversary-date-of-the- per-nit,-an- -- -- <br />operator shall 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 Drevious vear's map are necessarv, then no new man 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. lease verify and make any necessary <br />changes: <br />Permittee Contact: Nelson Selcer <br />Permittee Name: Jackson County <br />Address: P.O. Box 488 <br />188 Grant St. <br />Phone Number: <br />Fax Number: <br />Walden, CO 80480 <br />(970) 723-4481 <br />(970) 723-8437 <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 />enclos-ed'7 /I '1 -1-7 <br />r <br />Signature Corporate Officer, Owner, or Designee <br />Date <br />M:IPERMITMASTERDOCUMENTS\N4-AF-04