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'P4.v + ?T- <br />ANNUAL FEE and REPORT RE UEST <br />PERMITTEE NAME: Western Gravel, LLC <br />PERMIT NO.: M-2008-070 V/'FE6 2 2 2011 <br />OPERATION NAME: WRC Gravel Pit & Division of Reclamation, <br />Mining and Safoty <br />ANNIVERSARY DATE: February 24, 2011 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <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 />recl?irtli?StZ?ipisfied io daie 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 your revised written annual report and annual report may to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />ma . 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 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: Benton Jen <br />Permittee Name: Western Gravel, LILC <br />Address: P.O.808 <br />Meeker, CO 81641 <br />Phone Number: (970) 878-5564 <br />Fax Number: <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 Corpor e Officer, Owner, or Designee <br />r_?? <br />Date <br />.)G.?-1GV Vl\ l..i\.J. J'+-JG-11-V) VIN 11L 117.D v1VLt111kin 1,3 1ADt11 DL.