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ti <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~U ~ C <br />AN AL FEE and REPORT REQUEST <br />/Dilleys Sand & Gravel <br />"'M-1986-105 <br />Vondy Pit <br />August 29, 2007 <br />~ysion o 3 ~7pp7 <br />Mining a~tl Sa etyion <br />$323.00 (Due on or before your anniversary date) <br />Morgaa <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-aecomplished-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 yeaz, 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 moo to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />mau. If no new disturbances or reclamation have occurred durinti the previous year and no new chanties to <br />the previous year's moo are necessary, then no new moo is required, provided that the Ouerator 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 following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Vernon Dilley <br />Permittee Name: Dilleys Sand & Gravel <br />Address: 1914 Edmunds St. <br />P.O. Box 125 <br />Brush, CO 80723 <br />Phone Number: (970) 842-2810 <br />Fax Number: (970) 842-2284 <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 />Signature of Corporate Officer, O er, or Designee <br />'J - O <br />Date <br />