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4i?-- "t., R- ? 't <br />ANNUAL FEE and REPORT RE UEST I-ECEIVED <br />PERMITTEE NAME: YJack Clark Jr.?? QQ?9 LI/ <br />PERMIT NO.: M-2005-065 ,.exfilataRa <br />OPERATION NAME: Upper Animas Sand and Gravel Pit htar?;' .l <br />ANNIVERSARY DATE: December 8, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: San Juan <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 disturbangce --to a e Ed:. ?? el. v E <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 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 vear's map are necessarv. 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: Jack Clark Jr <br />Permittee Name: Jack Clark Jr. <br />Address: P.O. Box 767 <br />Silverton, CO 81433 <br />Phone Number: (970) 387-5243 <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 enclosed. <br />i ature of Corporate Officerwner, or Designee <br />Date