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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Permittee Contact: Edward J. Settle <br />Phone Number: (970) 243 -4604 <br />Fax Number: (970) 241 -6703 <br />Date <br />1(73 <br />v, #. Q <br />ANNUAL FEE and REPORT REQUEST <br />✓Grand Junction Pipe & Supply Co. <br />✓ M- 1997 -053 <br />Clifton Water Gravel Pit <br />October 3, 2011 <br />$791.00 (Due on or before your anniversary date) <br />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 />- reclam tion- accomplished to -date and -- during- the- apreced-inb year new- disturbances -that cra anticipated- te- oc-cur <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 Name: Grand Junction Pipe & Supply Co. <br />Address: P.O. Box 1849 <br />Grand Junction, CO 81502 <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 />Signature of Corpora e Officer, Owner, or Designee <br />ECF,TV's' 1x,, <br />a/S @'2 8 2011 <br />Division of t<eclamaiion, <br />Missing and Safety <br />