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4bz , <br />PERMITTEE NAME <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />r <br />r <br />FEt an REPORT REQUEST <br />Z wstorm Sand & Gravel, LLC <br />983-084 <br />Snowstorm Placer <br />July 28, 2010 <br />m <br />?UL U 6 2010 <br />piv+6`Dr, Of R.cg? won, <br />f 6 1.gini? inn <br />$$791.00 (Due on or before your anniversary date) <br />Park <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 tliat will be performed-during the coming year, th-e-dates for the beginning -' <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour 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 Cont ric c1t,_ <br />;\C) fttsl W4 I+A-) P?eA <br />Permittee Name: Snowstorm Sand & Gravel, LLC <br />Address: P.O. Box 1150 <br />Phone Number: <br />Fax Number: <br />Silverthorne, CO 80498 <br />(970) 468-2521 <br />(970) 468-2756 <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 ig re of 0?' ACD <br />Corpo to Officer, Owner, or Designee <br />`?-I• I <br />Date <br />