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'?-x <br />T REOUEST <br />PERMITTEE NAME: <br />PERMIT NO.: M 2000-092 <br />OPERATION NAME: Walsenburg Gravel Pit <br />ANNIVERSARY DATE: December 14, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Huerfano <br />slop <br />JAN 28 ?011 <br />Nuiwa of ts?' <br />Mb ft and fti* <br />_ __According_to_ C.B.S_ 34=5 11.6 or C..R.S -4.32Ti l ,_each year,_on -the-anniversary-date- of the, -permit, _an <br />operator shall submit the annual fee, a report and map showing the extent of ourrenf-& turbances 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 map 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 may 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 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: Alan Hein <br />Permittee Name: City of Walsenburg <br />Address: 525 S Albert <br />AN&FEE and G 'ty of Walsenburg <br />?/ <br /> <br />Walsenburg, CO 81089 <br />Phone Number: (719) 738-1048 <br />Fax Number: (719) 738-1875 <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 />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />l - Z?-ZULU <br />Date <br />M:\PERM Tq\ 1ASTERDOCUNE'NTS\M-AF-04 <br />-1 q • -) 3 S - k Qq ?< 4-4r,-1-e,A Sc (-r l Z-7-7- <br />