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<br />NV ? ?eT <br />ANNUAL FEE and REPORT RE UEST RECiEIVE <br />PERMITTEE NAME: y Weber Sand & Gravel, Inc. MAR 0 7 2011 <br />PERMIT NO.: J M-2007-010 DIVISIon of Rodemelon, <br />OPERATION NAME: Martinez fAning & Safety <br />ANNIVERSARY DATE: April 26, 2011 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Archuleta <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 />recramation actarnplisied-to ztate-and'during-tlie preceding year;-new disturbances that are - antfcipate-d 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 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 vear's man are necessarv. 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: Andy Weber <br />Permittee Name: Weber Sand & Gravel, Inc. <br />Address: 2980 E. Hwy. 160 <br />Pagosa Springs, CO 81147 <br />Phone Number: (970) 264-4568 <br />Fax Number: (970) 264-9089 <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 />Signatu a of Co ate Officer, Owner, or Designee <br />Date