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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />?I - cz?-r <br />ANNUAL FEE and REPORT RE UEST <br />Beavers Construction Co./High Mesa Gravel L.L.C. <br />M-2000-067 <br />RECE1V1fO <br />High Mesa Gravel Pit <br />March 15, 2011 ./MAR 312011 <br />yon, <br />eclamafcty <br />iningg 'and Reclamation, <br />DhAsion 0" Safety <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date , Mining' <br />Mini <br />COUNTY: Delta <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 accomplished to date 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 vour revised written annual report and annual report man 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 may 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 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: Phil Bourassa <br />Permittee Name: Beavers Construction <br />Address: 805 North Crest Dr # 101 <br />Grand Junction, CO 81506 <br />Phone Number: <br />Fax Number: <br />(970) 242-9485 <br />(970) 263-7818 <br />Co./High Mesa Gravel L.L.C. <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attac is form along with your written report and map. Annual Report instructions are enclosed. <br />Signa Corporate Offl6er; Owner, or Designee <br />Date