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<br />A 1z 4- AL FEE and REPOW-r <br />RT REQUEST MCMAft <br />PERMITTEE NAME: The Walsenburg Sand and Gravel Company 1/ APR 16 2010 <br />PERMIT NO.: M-2009-027 '40, D'wai.a or K'Tct:n <br />OPERATION NAME: WSG-Hribar "nrng;ad Safety <br />ANNIVERSARY DATE: May 8, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Huerfano <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 />e-- -- <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: Louis P. Vezzani <br />Permittee Name <br />Address <br />The Walsenburg Sand and <br />P.O. Drawer 352 <br />Walsenburg, CO 81089 <br />Phone Number: (719) 738-1883 <br />Fax Number: (719) 738-1883 <br />Gravel Company <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 />'- <br />A!5' <br />Signature of Corporate Officer, O or Designee <br />Date