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PERMITTEE NAME: Upland Gravel, Inc. RECEIVWD <br />PERMIT NO.: / M- 2005 -077 <br />1 JUN 29 2011 <br />OPERATION NAME: Upland Gravel Pit No. 3 <br />Division of Reclamation, <br />ANNIVERSARY DATE: July 5, 2011 <br />/9/ Division <br />and Safety <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Mesa <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />- reclamation-accomplished -to- date - and- during-the- preceding - year; - new - disturbances - that - are anticipated-to <br />during the 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 />Please attach your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Gary Rinderle <br />Data <br />Permittee Name: <br />Address: <br />Date <br />Phone Number: CF.PR.telephone_number <br />Fax Number: <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 enclosed. <br />Upland Gravel, Inc. <br />152 32nd Road <br />SI of Corporate Officer, Owner, or Designee <br />AL FEE and REPORT REQUEST <br />(ijLA- r) (gAV<< <br />02 5m( , TEL 17 ' ) <br />c <br />.�. u i .., GO g �_1 g Jilt/ 4anivt :Zen/ 0, 8 j S O3 <br />/7o_ �f 351 -oSio <br />q70- (3y- 6s7 c� <br />