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PERMITTEE NAME: <br />PERMIT NO.: <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 />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated 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: Jaime Sessions <br />M D Gtic� � 21 pasc's <br />Yfl'l p . 4- pros it mti g3SD cy <br />Permittee Name: Glenn E Sessions & Sons, Inc. <br />Address: <br />Phone Number: <br />Fax Number: <br />33492 Hwy 125 <br />P.O. Box 1076 <br />- -- Walden, CO 80480 - <br />(970) 723 -4944 <br />(970) 723 -8344 <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 Corporat! Officer, Owner, or De <br />Date <br />)0-J -4 <br />ANr Pt R <br />AL FEE and RE 412 REQUEST <br />Tr G lenn E Sessions & Sons, Inc. <br />4-2003-058 <br />Fairbanks Pit <br />December 4, 2011 <br />$323.00 (Due on or before your anniversary date) <br />Jackson <br />gnee <br />RECEIVED <br />i/ O EC 0 5 1011 <br />Division of Reclamation, <br />Mining &Safety <br />