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C t ~ ~~ <br />~~~~- <br />ANNUAL FEE and REPORT REQUEST <br />PERMTTTEE NAME: ~tio Grande County <br />PERMIT NO.: /M-1979-189 <br />OPERATION NAME: Rio Grande Sand Pit S-4 <br />ANNIVERSARY DATE: January 13, 2008 <br />ANNUAL FEE DUE: $$791.00 (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 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 />map. If no new disturbances or reclamation have occurred durinE the previous year and no new changes to <br />the urevious 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 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: Dennis Sandusky <br />Permittee Name: Rio Grande County <br />Address: 201 Santa Fe Dr. <br />Phone Number: <br />Fax Number: <br />Denver, CO 80223 <br />(303) 825-2211 <br />(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 are enclosed. <br />Signature of Corporate Officer, Owner, or Designee IZECEII/ED <br />Date <br />JAN 10 2008 <br />~ sio~~ ~~and Safety n <br />Mining <br />