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ANNUAL' EE and /Of' RE UEST <br />0 <br />PERMITTEE NAME: ? WT Excavating and Demolition LLC <br />PERMIT NO.: h M-1981-286 <br />OPERATION NAME: Thomas Gravel Pit 4 <br />ANNIVERSARY DATE: March 1, 2011 <br />1:*L <br />geco F90 <br />/FEB 2 8 2011 <br />V 9 d s e*F F-jVW <br />FEB 8, : e <br />?lt?sion ? ? , <br />Mining <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />According to C.R.S. 34-32_5-116 or C.R.S. 34-32-116, each year, on the annivers?e of the permit, a1_:_ -: <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances 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 vour revised written annual report and annual report may 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 chances to the previous year's map are necessary, then no new map 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 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: Ray Thomas <br />Permittee Name: RWT Excavating and Demolition LLC <br />Address: 3771 Road P <br />Wiggins, CO 80654 <br />Phone Number: (970) 483-7813 <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 <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />???/Z <br />Date <br />M: \PERMTT\MASTERDOCUMENTSUvt-AF-04 <br />