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' G.7Gt~ <br />ANNUAL FEE and REPORT REQUEST <br />~ECEP!!E® <br />PERMITTEE NAME: ~ Elbert County <br />PERMIT NO.: /M-2001-010 ~UL ~ 71006 <br />Division of Minerals and Geology <br />OPERATION NAME: Allison Gravel Pit <br />ANNIVERSARY DATE: August 14, 2006 <br />ANNiJAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Elbert <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 and map showing the extent of current disturbances 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, the dates for the <br />beginning 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. Please note that an <br />adequately labeled map that clearly delineates and inclfules the above elements may sake 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: Tim Sheridan <br />Permittee Name: Elbert County <br />Address: 809 Ute Ave. <br />Simla, CO 80835 <br />Phone-Number:. (.Z19)-SA1-2268 <br />Fax Number: (719) 541-2826 <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. Annua] Report instructions are <br />enclosed. <br />L~i/`-ci <br />Signature of Co p r to Of eer, Owner, or Designee <br />1 UG <br />Dafe <br />M:~PERMITVv1ASTERDOCUMENTS~M-AF-04 <br />