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~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Rio Blanco County <br />t~M-1998-054 <br />East Douglas Creek Gravel Pit <br />October 5, 2006 <br />n~~?z- <br />io-i~-~~ <br />RECEI!lEID <br />(1f'T ~ 7 7f1(!6 <br />~Qivision of Reclamation, <br />Mining and Safety <br />$688.00 (Due on or before your anniversary date) <br />Rio Blanco <br />cording toto C.R.S~a~16 or C.RS~4-32-11 , eac 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 your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinti the previous year and no <br />new chanties to the previous year's map 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 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: Ron Leeper <br />Permittee Name: Rio Blanco County <br />Address: 570 Second St. <br /> Meeker, CO 81641 <br />Phone Number: (970) 878-SGOl 970 ' R'rg' ~5f ~ <br />Fax Number: (970) 878-3396 <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 Corporate Officer, Owner, or Designee <br />Date <br />M:~PERMITNfASTERD000MEMSUI-AF-04 <br />