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pF ~- R4'r <br />ANNUAL FEE and REPORT REQUEST RECENED <br />PERMTI'TEE NAME: Mario Bassi and Josephine Bassi <br />PERMIT NO.: M-2000-110 / SEP 18 2001 <br />YR- <br />OPERATION NAME: North Farm Road Gravel Pit p(viaion of Reclamation, <br />ANNIVERSARY DATE: September 17, 2007 Nlrting and Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Rio Grande <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 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 your revised written annual report 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 />maD. If no new disturbances or reclamation have occurred durinff the arevious year and no new chances to <br />the arevious year's moo are necessary, then no new moo is required, 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 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: Mario Bassi <br />Permittee Name: Mario Bassi and Josephine Bassi <br />Address: 2000 N. Farm Rd. <br />Monte Vista, CO 81144 <br />Phone Number: (719) 852-3225 <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 />~k.~l`J~it-ct~ <br />Sig ature of Corporate Officer, Owner, or Designee <br />~.- i~ ©~ <br />Date <br />