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dAp <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />f <br />A ffAFEE and REPORT REOUEST <br />hington County <br />?ZS988-032 <br />Fassler Gravel Pit <br />May 18, 2010 <br />$$323.00 (Due on or before your anniversary date) <br />Washington <br />7PR CEIVED <br />2G£1 <br />Division of Realarttatlpp, <br />1?6 Mining & Safety <br />According to-C-RS_?4?3-2.51Lfz nr C R S t4-? -11f_ e?chF. e , he ana e_rsaEy date of the permit, aA , . ? <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: 150 Ash Avenue <br /> Akron, CO 80720 <br />Phone Number: (970) 345-2701 <br />Fax Number: (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 <br />Signature of orporate Of cer, Owner, or Designee <br />Date <br />M:IPERMITVMASTERDOCUMENTS WI-AF-04