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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY:. <br />La Poudre Sand & Gravel <br />olG- <br />CFWD <br />AN 2 5 2010 <br />Dlrisiorl ut r :WWWP? <br />MW9 as" <br />January 17, 2010 <br />$$791.00 (Due on or before your anniversary date) <br />Weld <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 />-- rdb-lTmation accomplished-to date-and-during the -preceding-year,-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 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: Jim McFarland <br />Permittee Name: Hall Irwin Corporation <br />Address: 301 Centennial Drive <br />Milliken, CO 80543 <br />Phone Number: (970) 587-7277 <br />Fax Number: (970) 587-7287 <br />15?j ANNUAL E and REP &RR0UEST <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 />re of orate O icer, wrier, or Designee <br />EHall Irwin Corporation <br />LM-1983-090 <br />I Its 1 2a <br />Date