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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ✓ Rowe Gravel <br />PERMIT NO.: / M- 1999 -038 <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <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 />.1 • <br />1' . <br />. .. .1 1 <br />• <br />. - • - . <br />, - 1 � 1 s .1 a • - . cipatd to occur <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: Brad W. Rowe <br />Permittee Name: Rowe Gravel <br />Address: <br />Phone Number: <br />Fax Number: <br />9134 CR 100 <br />Hesperas, CO 81326 <br />(970) 588 -2277 <br />* R PT <br />-IE- - -v <br />`SEP2i <br />c/ c / Division of Keclamation, <br />Rowe Gravel Mining and Safety <br />September 21, 2011 <br />$323.00 (Due on or before your anniversary date) <br />La Plata <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 />u <br />Signature of Corporate Officer, Owner, or Designee <br />Sip\' ) fi r II <br />Date <br />