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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ADTaAL FEE and REPORT REQUEST <br />qVAll, <br />paul Morgan Excavating, Inc. <br />//M-2006-077 <br />Morgan Pit <br />January 31, 2011 <br />$323.00 (Due on or before your anniversary date) <br />Huerfano <br /> <br /> <br />r' -S c ..i ?iwY9, <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-the -upcomhrg-year, --reclamation-that will be-performed-duringthe coining 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 man 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: Paul Morgan <br />Permittee Name: Paul Morgan Excavating, Inc. <br />Address: 581 County Road 420 <br />P.O. Box 82 <br />--- - L4z pT? Co R d oS5 <br />Phone Number: (719) 742-3155 <br />Fax Number: (719) 742-3155 <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 />Signature of orporate cer, Owner, or Designee <br />zkG, <br />Date