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~~~Pi <br />ANNUAL ~EE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Eddie Clayton <br />X14-1999-022 <br />Clayton Sand and Gravel <br />July 19, 2007 <br /> <br />RECEIVED <br />~UL 1 E 2001 <br />Dyision of Reaamation, <br />Mining and Safety <br />$$281.00 (Due on or before your anniversary date) <br />Saguache <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 dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual resort 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 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: Eddie Clayton <br />PermitteeName: Eddie Clayton /[/~1 ~~/ 1~1 ~~/ <br />Address: P.O. Box 2 / tv T~~ L~7 / .L''9/1 <br />Hooper, CO 81136 <br />Phone Number: (719) 378-2392 <br />Fax Number: <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 Corp ate Officer, Owner, or Designee <br />~~ Z/~'`~ <br />Dat <br />