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• III IIIIIIIIIIIIIIII • <br /> 00 <br /> sss <br /> ANNUAL FEE and REPORT REQUEST <br /> PERMITTEE NAME: Western Gravel, Inc. RECEIVE <br /> PERMIT NO.: M-1984-108 DEC 18 20CJ <br /> OPERATION NAME: Olathe Pit <br /> Division of Minerals and — <br /> ANNIVERSARY DATE: December 14,2000 <br /> ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br /> COUNTY: Montrose <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary da a of the permit, an <br /> operator shall submit the annual fee, a report and map showing the extent of current dist rbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning 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 man to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written: <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and ake any necessary <br /> changes: <br /> Permittee Contact: Joseph DeVincentis <br /> Permittee Name: Western Gravel, Inc. <br /> Address: 3001 N. Townsend Ave. <br /> Montrose, CO 81401 <br /> Phone Number: (970)249-2431 <br /> Fax Number: 96 — a — t7 59 Z <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 <br /> enclosed. <br /> Ignatur f Corporate Officer or Owner <br /> / 2-- Qr� <br /> Date <br /> M NEWITIMASTERDOCUNIENTSN1-AF-01 <br />