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A FEE and REPORT REQUEST <br />PERMITTEE NAME: _ Elbert County <br /> / l JUG 2 <br />PERMIT NO.: / M-2001-010 ~ ZQ~~ <br />OPERATION NAME: Allison Gravel Pit `/UivMin ~ °f Rectarnation, <br />9 and S <br /> afety <br />ANNIVERSARY DATE: August 14, 2007 <br />ANNUAL FEE DUE: $791.00 (Due on or before you r anniversary date) <br />COUNTY: Elbert <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances 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 vour revised written annual report and annual resort mao to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated maa. If no new disturbances or reclamation have occurred durinc the previous year and no <br />new chances to the previous year's mao are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Tim Sheridan <br />Permittee Name: Elbert County <br />Address: 809 Ute Ave. <br />Simla, CO 80835 <br />Phone Number: (719) 541-2268 <br />Fax Number: (719) 541-2826 <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 />Signature of Co orate Offi ,Owner, esignee <br />i/ 0 7 <br />Date <br />~~~~~ ~~~ <br />M:~PERMI'IVMASTERDOCUMEM54M-AF-04 <br />