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'1 <br /> <br />ANNUAL FEE aad REPORT REQUEST <br />PERMITTEE NAME: Suburbaa Saad & Gravel Co. <br />PERMIT NO.: M-1479-195 <br />OPERATION NAME: Road Ruaaer Rest <br />J%a': C 9 ZOUb <br />C~c .- _. ~ si. <br />M:h,9~g 2'd ~:;;;:y <br />RECEIVED <br />JAN 0 9 2001 <br />ANNIVERSARY DATE: January 28, 2007 <br />Divisron a n:.ci>~nation, <br />ANNUAL FEE DUE: $5688.011 (Due oa or before your anniversary date) Mining and Safety <br />COUNTY: Adams <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 16, each yeaz, 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 aze 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 vour revised written annual report and annual resort roan to this form. The Anaual Report <br />& Fee requirement is not met until we have received the following components: fee. report, and associated <br />IDSD. If ao new disturbances or reclamation ha': a occurred duriae the are~'ious veer aad ao new changes to <br />the~trevious (tear's _map are necessary, theu no new m~ is re9uired, 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 su~ee jor a wrirren report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Dean H. Croft <br />Permittee Name: Suburban Sand & Gravel Co. <br />Address: 5400 Fenton St. <br />Phone Number: <br />Fax Number: <br />Arvada, CO 80002 <br />(303)421-0720 <br />(303)467-0411 <br />If you have additional cotnments 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 />Date <br />