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PERMITTEE NAME: 1/Meeker Sand & Gravel, Inc. <br />PERMIT NO.: / M- 1976 -038 <br />OPERATION NAME: Meeker Pit <br />ANNIVERSARY DATE: July 25, 2011 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <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 _shed to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that wirbe 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: Joe P. Conrado <br />Permittee Name: <br />Address: <br />Meeker Sand & Gravel, Inc. <br />3251 RBC #4 <br />P.O. Box 1550 <br />Meeker, CO 81641 <br />Phone Number: (970) 878 -3671 <br />Fax Number: (970) 878 -5751 <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 />Si <br />ture of Corporate <br />7- Zo -2o/ <br />Date <br />fficer, Owner, or Designee <br />AL FEE and REPORT REQUEST <br />RECEV <br />✓ JUL 2 5 2011 <br />Division of Reclamation, <br />Mining and Safety <br />