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12/10/2012 2:20 PM MT Fax Services <br />)i 13038328106 ® 2 <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: MaskRancb, LLC <br />PERMIT NO.: M- 2002 -0$7 <br />OPERATION NAME: Mask Ranch Gravel Pit <br />ANNIVERSARY DATE: November 25, 2011" 20 /1-- <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniver$ary date) <br />COUNTY: Archuleta <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 date¢ for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />fleas. attach your revised written annual report and annual report map to this form. Tke Annual Report <br />& Fee requirement is not met until we have received the following components: fee. re and associated <br />lat. If no new disturbances or reclamation have occurred durinu the previous year and new changes to . <br />the previous year's MD are necgsav, thee no new man is requir* provided that the rater shall state <br />this in the Annual Report. Please note that an adequately labeled map thaticlearly delineates and includes the <br />above elements may selee for a written report. <br />Division records indicate the following permittee contact information. Please verify and nilake any necessary <br />changes: <br />Permittee Contact: 27oaairYaer <br />'ham P u�� <br />Permittee Name: MaskRanch, LLC <br />A xe L <br />Address: esc�Wry" t7 3� <br />4)116414 'P 7 <br />Phone Number. (41+6)-59.3.,934-- Lj Q+}( 307 f f <br />Fax Number: 4846)-5(13-2-770 ff a - 9,6 .. <br />If you have additional comments and/or information that should be provided to the Division please provide it <br />be + h it to tl brm along with your written report and map. Annual Report instructions are enclosed. <br />Signa t of C <br />ate <br />e <br />Owner, or Designee <br />RECEIVED <br />DEC 10 2017 <br />