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%~4 ~P i 'r <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEENAME: i/ Rio Grande Co. ~~~P~~~`~~~ <br />PERMIT NO.: '~M-1979-189 ~` AN ~ 9 ZdQ~ <br />OPERATION NAME: Rio Grande Sand Pit S-4 ~roisi°n °f ReCiamation, <br />Mining and Safety <br />ANNIVERSARY DATE: January 13, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Arapahoe <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 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. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to <br />the previous year's map are necessary, then no new map 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 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: <br />Permittee Name: <br />Address: <br />Dennis Sandusky <br />Rio Grande Co. <br />201 Santa Fe Dr. <br />Denver, CO 80223 <br />Phone Number: (303) 825-2211 <br />Fax Number: (303) 575-0040 <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 aze enclosed. <br />( .,,~.: ti <br />'gnature of Corpora e Officer, Own r or Designee <br />/ .'~" <br />Qa/, /7 20 <br />Date <br />