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~~ / <br />ANNiiAI, FF.F, and RRPtIRT RF.niTF.ST <br />.~ ~ ~~~~ <br />PERMITTEE NAME: Ri Blanco County -' <br />PERMIT NO.: t/M-1998-054 <br />OPERATION NAME: East Douglas Creek Gravel Pit <br />ANNIVERSARY DATE: October 5, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <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 <br />operator shall submit the annual fee, a report grid map showing the extent of current disturbance's to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, [he dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annnal rennrt and annnal report main to this form. Please note thal an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ron Leeper <br />Permittee Name: Rio Blanco County <br />Address: 570 Second St. <br />Meeker, CO 81641 <br />Phone Number: (970) 878-5601 <br />Fax Number: (970) 878-3396 <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 <br />enclosed. <br />~ ~~~.. <br />Signature of Corporate Officer, Owner, or Designee <br />9-7-0~ <br />Date <br />M:WERMITVNASTERD000MENTSU.]-AF-04 <br />