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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />v Frank Gilmore <br />M- 1983 -209 <br />Benton Dawson Gravel <br />July 25, 2011 <br />$323.00 (Due on or before your anniversary date) <br />Delta <br />ECENEZ <br />7 AUG 0 6 2011 <br />Division of Reclamation, <br />Mining and Safety <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_ ofcurr _ent_disturbances_to_aifected — <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 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 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: Frank Gilmore <br />Permittee Name: Frank Gilmore <br />Address: <br />Phone Number: <br />Fax Number: <br />5998 Sawmill Mesa Road <br />Delta, CO 81416 <br />(970) 874 -5157 <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 />JaqvUt.A. <br />ature of Corporate Officer or Owner <br />8-S -.?,(5/) <br />Date <br />Si <br />