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Trl-? <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />/ <br />A AL FE?fan REPORT REQUEST <br />P-DIeys Sand & Gravel <br />Ayers Pit <br />February 2, 2011 <br /> <br />Rec ?- <br />JAN <br />40 D1vls,'on <br />l!/lirtf.'C' <br />#Ipn? <br />$$323.00 (Due on or before your anniversary date) "e`y <br />Morgan <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 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 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 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Vernon Dilley <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Dilleys Sand & Gravel <br />1914 Edmunds St. <br />P.O. Box 125 <br />Brush, CO 80723 <br />(970) 842-2810 <br />(970) 842-2284 <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 Corporate Officer, wner, or Designee <br />/- /17- <br />Date