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~,,u) <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />V ANNUAL FEE and REPORT REQUEST <br />/L.G. Everist, Inc. <br />I/ M-2001-017 <br />Lohmann Sand and Gravel Mine <br />September 19, 2006 <br />RECEIU <br />ED <br />~~~SEP 1 12006 <br />'~ Division of Reclamation, <br />Mimn9 and Safety <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />~~ °~ <br />According to C.R.S. 34-32.5-1 16 or C.R.S. 34-32-1 16, 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 vour 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 />map (All are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />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: Lynn Mayer <br />Perrnittee Name: L.G. Everist, Inc. <br />Address: 7321 E. 88th Ave. Ste. 200 <br />Henderson, CO 80640 <br />Phone Number: (303) 287-4656 CWIGn n J <br />Fax Number: (303) 289-1348 / <br />~ M~~~~ul~_s <br /> <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 />of C orate Officer, <br />~ ~~D1~ <br />Date <br />