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~" ~ <br />'- 1 ` I <br />AL FEE and REPORT REQUEST <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~I.eone Sand and Gravel LLC <br />/M-1994-006 <br />Emerald Vista Estate <br />March 11, 2008 <br />$$323.00 (Due on or before your anniversary date) <br />Las Animas <br />R~~d !~` <br />2 9 2008 <br />ivision of ~toclvmation, <br />Mining and Safety <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,-rew-disturbarioes-ti~at 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 man to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />mau. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new man 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: Frank L. Leone Jr <br /> ~~ <br />Permittee Name: Leone Sand and Gravel LL <br />Address: 502 S. Walnut St. <br /> Trinidad, CO 81082 <br />Phone Number: (719) 846-4170 <br />Fax Number: (719) 845-0605 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below o~r attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />(` l~ <br />~I ~2~~~ ~ c~~~ O~Gc~yZ~~~ <br />Signature of Corporate Officer, Owner, r Designee <br />~~~~~~ <br />Date <br />