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<br />iA-P * Q 97 <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: '? Elam Construction, Inc. RECEIVRO <br />PERMIT NO.: M-1980-085 FEB 2 2 2011 <br />OPERATION NAME: Vagneur Site Division of Reclamation, <br />ANNIVERSARY DATE: February 17, 2011 Mining and Suety <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Pitkin <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 accompiis=hed-tordaire -and--during-the recede year, new AiAaf ances that are -an-ticipated-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 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: Stephen Kaspar <br />Permittee Name: Elam Construction, Inc. <br />Address: 556 Struthers Ave <br />Grand Junction, CO 81501-3826 <br />Phone Number: (970) 242-5370 <br />Fax Number: (970) 245-7716 <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 />y <br />Signature o orporat f er, ner, or Designee <br />17 "Z ZI/ <br />Date <br />