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AL FEE and REPORT REQUEST <br />PERMITTEE NAME: 'Washington County <br />PERMIT NO.: -I-1988-032 <br />OPERATION NAME: Fassler Gravel Pit <br />ANNIVERSARY DATE: May 18, 2011 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Washington <br /> <br />RECEIVED <br />`ERR 13 2011 <br />Division of Reclamation, <br />Mining & Safety <br />A,ccordin?to C $ S_ 34 32.5-.116 or C_R.S._34-32-116_, each year, on the anniversary date of the permit, an <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 your revised written annual report and annual report map 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 changes 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: Clinton Mehring <br />Permittee Name: Washington County <br />Address: <br />Phone Number: <br />Fax Number: <br />150 Ash Avenue <br />Akron, CO 80720 <br />(970) 345-2701 <br />(970) 345-2702 <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 />encl e 'I'l '00e? <br />-91"g-nature of Corporate O icer, Owner, or Designee <br />Date <br />M: TERMITq?4AS TERDOCUMENTS\N4-AF-04