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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />NF*PIP I' <br />ANNUAL FEE and REPORT RE VEST <br />Precision Excavating, Inc. <br />.? M-2009-079 <br />Peroulis Brothers Snake River Pit <br />January 6, 2011 <br />'-DEC 2 0 2010 <br />Divwm et KecWWWOR. <br />Wine awd fti* <br />$791.00 (Due on or before your anniversary date) <br />Moffat <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 preccdtg_year, new -disturbances- that-are anticipated-tooccur - - - <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 year's map are necessary, then no new may 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: David S. Zehner <br />Permittee Name: Precision Excavating, Inc. <br />Address: l o< <? s-or'-ii?rwn <br /> <br />Hayden, CO 81639 <br />Phone Number: (970) 276-3359 <br />Fax Number: (970) 276-3084 <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 />n <br />Signature of Corporate ?cer, Owner, or Designee <br />1??1(o /10 <br />Date