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~~ ~. ~ p~r <br />ANNUAL FEE and RfE~PORT REQUEST <br />PERMITTEE NAME: Cecil C Powell v <br />PERMIT NO.: M-1995-012 / <br />OPERATION NAME: Powell's Gravel Pit <br />ANNIVERSARY DATE: May 12, 2008 <br />ANNUAL FEE DIJE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <br />~~~~ <br />APR 1 a 2008 =/ <br />Division of Reclamation, <br />1Viining 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,_new disturbances that are anticipated to occur <br />-- -during-the-upcomingyear,-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 previous year's map are necessary. then no new map is reauired. 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: Cecil C. Powell <br />Permittee Name: Cecil C Powell Nn M i n i m h a m h P P n r9 ~ p A <br />Address: P.O. Box 23 a t this site . <br />Dinosaur, CO 81610 <br />Phone Number: (970) 374-2329 <br />Fax Number: <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 <br />Date <br />