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cv,AG <br />ANN AL FEE and REPORT REQUEST F 0 g <br />? CF-w <br />J0 ? 2011 <br />PERMITTEE NAME: kW shington County Road & Bridge District 2 Division of Reclamation, <br />PERMIT NO.: 2010-009 Wt,,vng and Safety <br />OPERATION NAME: Colorado Land Board Pit <br />ANNIVERSARY DATE: June 10, 2011 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Washington <br />According-to C.R.S. 34-32,5-1.16 or CR.S. 3.4-32-11.6,.-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 may. If no new disturbances or reclamation have occurred duriny- the previous year and no <br />new chanp_es 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: MM <br />Permittee Contact: Jesse Stackhouse ;? az . A L'oc11C414 <br />Permittee Name: Washington County Road & Bridge District 2 <br />Address: -50r4th Ave. <br />Otis, CO 80743 <br />Phone Number: (970) 246-3347 <br />Fax Number: (970) 246-3347 <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 />of Corporate Officer, er, or Designee <br />;ature <br />"d) <br />-5-9- U <br />Date <br />M: TERMITIMASTERDOCUMENTS\M-AF-04