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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />(I- <br />,/Cit Ci of Grand Junction <br />y <br />✓ M- 2007 -005 <br />Riverside Parkway <br />February 14, 2010 <br />MAR 01 2010 <br />7 Division of RwAmadon, <br />k4ning and SO* <br />$504.00 (Due on or before your anniversary date) <br />Mesa <br />Accordi to C. R.S. 3 4 - 3 2.5 -11 or_C._R.S 34 - 32_116, each year,, on- the anniversary date_ of the -permit, 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 may 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 chanzes to the previous year's may are necessary, then no new map 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 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: James L. Shanks <br />Permittee Name: City of Grand Junction <br />Address: 2529 High Country Ct <br />Grand Junction, CO 81501 <br />Phone Number: (970) 244 -1543 <br />Fax Number: (970) 256 -4014 <br />D PA(AL_ 3AU1r, <br />CITY 0 1-:� G2ArXr3 J +nrJG' , '70 1J <br />Z So N . 5 41 " S �- ft ECT <br />(� RA►y� •�un+r - T - 10r) i co f3 /SO l <br />(9 zyy- JS <br />( 97o) 2Sb - Ll0 Z z <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 />enclosed. <br />Signature of Co orate bfficer, Owner, or Designee <br />z/ i8 //o <br />Date <br />M: IPERMITIMASTERDOCUMENTS\M -AF -04 <br />