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'^ 05/06/2011 07:20 <br />PERMTITirE NAME: <br />PERMIT NO.: <br />OPERAITON NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />9708784489 <br />PETROX <br />ANNUAL E EE and REPORT REQUEST <br />Tierra Piedra Ranch LLC <br />M-2009-081. <br />Tierra Piedra Gravel Pit <br />may 19, 2011 <br />$323.00 (Due on or before your anniversary date) <br />Archuleta <br />PAGE 02/02 <br />According to G.R.S. 3432.5-11.6 or C.R.S. 3432-116, each year, on the anniversary date of thepermait, an operator <br />shall submit the annual ,fee, a report and map showing the extent of current disturbances to affected land, <br />reclam t" on accomplished to date and during the preceding year, new disturbances that are anticipated. to occur <br />during th1 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 />.rlease a c our revr a mien annul re ort and annual re ort a to this fonn, The Annual Report <br />& Fee r quirement is not met until we have received the following components: fee re o and associated <br />man. o new disturbances or reclamation have occurred dnrina the nrevians vnar and nn ram rhanapa +n <br />this in t e nnual Re . Please note that an adequately labeled map that clearly delineates and includes the <br />above elebnents may suffice for a written report. <br />Division Lcords indicate the following permittee contact information. Please verify and make any . necessary <br />charges: <br />Permittee Contact: M*oEiark <br />Sias; M ?s <br />Permittee Name: <br />Address: P.D Rox 1959 d Q R SA <br />_SU tm-F- S 2 <br />AAel nn 8*22 ?? 69 <br />Phone Number- (97() -883269 ?{pJ f 4- O 1 I Ile) <br />Fax Number: (97-0)-878-"89 ?OS N0 9 S 1 fj <br />If you dditional comments and/or information that should be provided to the Division, please provide it <br />Belo or a h it to this form along with your written report and reap. Annual Report instructions are enclosed. <br />Corporate Officer, Owner, or Designee <br />x ?' Z-QI 1 <br />Date ?-