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0. t? -- R+-r <br /> ANNUAL FEE and REPORT REOUEST <br /> <br /> <br />PERMITTEE NAME: L' <br />Rio Blanco County <br />PERMIT NO.: / <br />? M-2000-037 <br />OPERATION NAME: Baxter Pass Gravel Pit <br />ANNIVERSARY DATE: May 10, 2011 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <br />W 'D <br />MAY 02 nil <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 - - <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 man 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 suff ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: David P. Morlan <br />Permittee Name: Rio Blanco County <br />Address: 570 2nd St. <br />Meeker, CO 81641 <br />Phone Number: (970) 878-9590 <br />Fax Number: (970) 878-3396 <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 />ature of Co? o to Officer, Owner, or Designee <br />Date <br />M:\PERAMWASTERDOCUMENTS\M-AF-04