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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />Alf- <br />ANNUA FEE And ORT REQUEST <br />V?ajm Construction, Inc. <br />980-085 <br />_? rm <br />?C?oVED <br />P9AR 10 2090 <br />OPERATION NAME: Vagneur Site Division of Reclamation, . <br />ANNIVERSARY DATE: February 17, 2010 46 Mining & Safety <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Pitkin <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 ant-icipated-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 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 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: Stephen Kaspar <br />Permittee Name: Elam Construction, Inc. <br />Address: 556 Struthers Ave <br />Grand Junction, CO 81501-3826 - <br />Phone Number: (970) 242-5370 <br />Fax Number: (970) 245-7716 <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 />Signature orp to- fice , Owner, or Designee <br />Date