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~~ <br />~- ~~ ~ R~ <br />ANNUAL FEE and PORT REQUEST <br />PERMITTEE NAME: MMM Partnership <br /> ~ <br />PERMIT NO.: / M-2006-042 <br />OPERATION NAME: MMM Partnership Gravel Pit <br />ANNNERSARY DATE: June 20, 2007 <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: Logan <br /> <br />F'~~~ 1 R ?i~(~7 <br />~Ivf^F5: ~ ~IGR, <br />fv~in:r,:.. cc' .r;~;y <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_renortand_map~howing_the_extent_of_current dishrrbances_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 vour 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 />man. If no new disturbances or reclamation have occurred during the previous year and no new chances to <br />the previous year's man 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 since for a written report. <br />Division records indicate the fallowing permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mark Kokes <br />Permittee Name: MMM Partnership <br />Address: 15160 Hwy. 144 Lot 18 <br />Fort Morgan, CO 80701 <br />Phone Number: (970) 867-3624 <br />Fax Number: (970) 867-3055 <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 />Sign a of Corporate Officer, Owner, or Designee <br />Date <br />