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PC -* (2p)- <br />ANNUAL FEE and REPORT RE VEST <br />PERMITTEE NAME: Weber Sand & Gravel, Inc. ENED <br />PERMIT NO.: / M-2007-010 MAR 19 2010 <br />OPERATION NAME: Martinez Dtv*tion of hecla mation, <br />ANNIVERSARY DATE: April 26, 2010 Wing and $gfgtj/ <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Archuleta <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 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: Andy Weber <br />Permittee Name: Weber Sand & Gravel, Inc. <br />Address: 2980 E. Hwy. 160 <br />Pagosa Springs, CO 81147 <br />Phone Number: (970) 264-4568 <br />Fax Number: (970) 264-9089 <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 />4v6t,_AdajL_, <br />Signatur of Co ate Officer, Owner, or Designee <br />0-19-10 <br />Date