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<br /> <br /> <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />V(?_N Colo Water Conservancy Dist. <br />? M-1981-085 <br />Riprap Quarry Area <br />RECEIVED <br />f JUL 12 2010 <br />t? Division of Reclamation, <br />Mining & Safety <br />July 21, 2010 <br />$791.00 (Due on or before your anniversary date) <br />Grand <br />According--to C.R.S. 34-32.5-116 or C. S. 34-32-11-6; 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 map 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 chances to the previous year's map 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 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: Jim Struble <br />Permittee Name: N Colo Water Conservancy Dist. <br />Address: 220 Water Avenue <br />Berthoud, CO 80513 <br />Phone Number: (970) 532-7700 <br />Fax Number: (970) 532-0942 <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 />Si ature of- to Officer, Owner, or Designee <br />7/712 o1 <br />Date <br />M: PERMITIMASTERDOCUMENTS\M-AF-04