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r~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~~~~i <br />ANNfiAi. FFF, and REPORT RF,niiF.ST <br />Rowe Gravel <br />1VI-1999-038 <br />Rowe Gravel <br />September 21, 2005 <br />SEP 9 21005 <br />-/p Division m ,ui,,,e~o„ ane Geology <br />$281.00 (Due on or before your anniversary date) <br />La Plata <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 ynnr revised written anneal report and anneal re nn rt map to this form- Please note that an <br />adeguatedy labeled map that clearly delineates and includes the above elements nray 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: Brad W. Rowe ~\ ~, C h~~ c Q <br />Permittee Name: Rowe Gravel <br />Address: 9134 CR 100 <br />Hesperas, CQ 81326 <br />--'Piio<ie i~lumber:"'-(970)-588=2277 <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 Corporate Officer, Owner, or Designee <br />Sen~~ `7' oS <br />Date <br />