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ANNUAL FEE and EPORT QUEST <br />PERMITTEE NAME: Grand my Department of Road & Bridge <br />PERMIT NO.: M-2006-029 <br />OPERATION NAME: South Fork Gravel Pit (aka Williams Fork) <br />RECEIVED <br />'01AG 11 2010 <br />ANNIVERSARY DATE: August 28, 2010 Division of Reclamation, <br />Mining & Safety <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Grand <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 an_d m_ap 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 vour revised written annual report and annual report may 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: Bill Clark <br />Permittee Name: Grand County Department of Road & Bridge <br />Address: P.O. Box 9 <br />Granby, CO 80446 <br />Phone Number: (970) 887-23-23- <br />Fax Number: (970) 887-3168 <br />C9'7 07 SS __2 - Z 17- 3 <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 />Signatur of Corporate Officer, Owner, or Designee <br />/?//3/ 24! 0 <br />Date