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t- <br />klor <br />ANJfFEE and REPORT RE UEST <br />PERMITTEE NAME: The Walsenburg Sand and Gravel Company <br />PERMIT NO.: -M-2009-027 <br />OPERATION NAME: WSG-Hribar <br />ANNIVERSARY DATE: May 8, 2011 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Huerfano <br /> <br />RECEIVED <br />CPR 13 2011 <br />Divislon of Reclamation, <br />710 Mining & Safety <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 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 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: Louis P. Vezzani <br />Permittee Name: The Walsenburg Sand and Gravel Company <br />Address: <br />Phone Number: <br />Fax Number: <br />P.O. Drawer 352 <br />Walsenburg, CO 81089 <br />(719) 738-1883 <br />(719) 738-1883 <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 />S gnature o Corporate Officer, er, or Designee <br /> <br />Date