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~s <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />v ANNiiAi. FF,F, and RF,PnRT RF.n1TFST <br />1//Louisiana Laud and Gravel Company, LLC <br />t/ M-2000-049 <br />Angie Pit <br />Apri19, 2006 <br />~' MAY 1 5 zu;;e <br />/Oivision of Mine~ais mm ~eofogy <br />$688.00 (Due on or before your anniversary date) <br />Montrose <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 accompIishe 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 yeaz, if any. <br />Please attach ynnr revised written anneal rennrt and anneal re r,~~ t map to this form- Please note that an <br />adequately labeled map that clearly 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: Michael A. DeJohn <br />Permittee Name: Louisiana Land and Gravel Company, LLC <br />Address: P.O. Box 8419 <br />Clinton, LA 70722 <br />Phone Number: (225) 683-3358 <br />Fax Number: (225) 683-3802 <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 />NQ/tk WY/hwcs,Znc. <br />aBA: W//yams ConS~+c~+'on Cw~.~rrc,~ <br />~~O"~~c~'n~or <br />Signature of orporate Officer, Owner, or Designee <br />Date <br />