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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />AL FEE and REPORT REQUEST <br />?Meeker Sand & Gravel, Inc. <br />/ M-1976-038 <br />? Meeker Pit <br />July 25, 2010 <br />JUL 19 2010 <br />Y Dh*jan of "`w ?_„ <br />Mini cw?,-'won <br />Ind Suety <br />$791.00 (Due on or before your anniversary date) <br />Rio Blanco <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 P gy p g the ii comet ear; reclamation that w-iTl-be -e"rforme urin tTie comin -ear tpie fiates` or`tfie be- nnin <br />gY g g <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 may 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: Joe P. Conrado <br />Permittee Name: Meeker Sand & Gravel, Inc. <br />Address: 3251 RBC #4 <br />P.O. Box 1550 " <br />Meeker, CO 81641 <br />Phone Number: (970) 878-3671 <br />Fax Number: (970) 878-5751 <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 />4 . Z - <br />ature of Corporate Officer, Owner, or Designee <br />Date