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4,F *- ?f <br />ANNUAL FEE and REPORT REOUEST <br />r ??t?ld <br />PERMITTEE NAME: "'Montrose County <br />ZQ?? <br />PERMIT NO.: / M-1987-151 S 27 <br />OPERATION NAME: Soderquist Pit Division u .. <br />Wing and Sa(: ty <br />ANNIVERSARY DATE: October 28, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Montrose <br />- _-Accordir g to-C:I-:ST-3442.-S14-6--or-C4t-:S 34=3-2?1i-6, each gear°orr a ermi, 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 man 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 changes 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: Brian Wilson <br />Permittee Name: <br />Address: <br />Montrose County <br />949 N. 2nd Street <br />Montrose, CO 81401 <br />Phone Number: (970) 252-7000 <br />Fax Number: <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 />4ateu"re- d. , <br />of Corporate Officer, Owner, or Designee <br />S' <br />Date <br />M:\PERMT OAASTERDOCUMENTS\A4-AF-04