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?A <br />P-' <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />6?r <br />ANNUA FEE and RT REpUEST <br />Raymond C. Petersen <br />M-1981-236 <br />Colorado River Ranch Gravel Pit <br />March 29, 2010 <br />$791.00 (Due on or before your anniversary date <br />Grand <br />/FEE 2 2 2090 <br />ox- <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-tli-?preceding year,-ne -- is°tirr'oaircesF-that are antic ipatea 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 vear's man are necessarv. then no new man is reauired. 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: Raymond C. Petersen <br />Permittee Name: Raymond C. Petersen <br />Address: P.O. Box 832 <br />Kremmling, CO 80459 <br />Phone Number: (970) 724-9327 <br />Fax Number: (970) 724-9327 _ <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below-qr attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />of <br />February 16, 2010 <br />er, or Designee <br />Date