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*' ?: 'k- RpX <br />?A?vNNUAL FEE and REPORT REQUEST CEIVIEt) <br />PERMITTEE NAME: Donald R Hart L r 2 b ZQ,? <br />PERMIT NO.: /M-1980-049 0Ivialon of Reclamation, <br />OPERATION NAME: Mott Gravel Pit Mining & Safety <br />ANNIVERSARY DATE: February 18, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: 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-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 may 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 map are necessarv, 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Donald R. Hart <br />Permittee Name: Donald R Hart <br />Address: 3500 Clear Fork Rd. <br />Crawford, CO 81415 <br />Phone Number: (970) 921-5299 <br />Fax Number: <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 />a <br />Si ` re of Corporatd'Officer, Cfwner,, or Designee <br />_"2010 <br />?--? /?// <br />Date