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PERMITTEE NAME: C B Sand and Gravel Inc. / rl t <br />PERMIT NO.: -2007-058 Drvrs of <br />Iamatron, <br />Mion :nrng Re & Safety <br />OPERATION NAME: Sheehan Pit J <br />ANNIVERSARY DATE: February 11, 2012 77 � <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <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: John A. Corson <br />Permittee Name: C &B Sand and Gravel Inc. <br />Address: P.O. Box 147 <br />Phone Number: <br />Fax Number: <br />Si <br />Date <br />at <br />Baggs, WY 82321 <br />< 8 1 <br />(307)3-8.4-7003 <br />30 '7 . -11 �� <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 />*MI ah.__A <br />re of Corporate Officer, Owner, or Designee <br />ANN AL FEE and RE O T REQUEST <br />RECEI VED <br />