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~~ ~r ~~ <br />ANNUAL FEE and REPORT REQUEST ~~~~~~~® <br />PERMTI"TEE NAME: Central Aggregates, Inc. <br />PERMIT NO.: M-1981-006 / APR ~ 9 2008 / <br />l7ivision or ~ecPamation <br />OPERATION NAME: West Rifle Pit Mining and Safety '~ <br />ANNIVERSARY DATE: Apri127, 2008 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Garfield <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 />_.__ :~_~r-eclamation-accomplished-to-date-and~iduring-thg-precedinb year; ne~~-disturba:.ees-tYi~t a~ "~- ~';,'~ated-tc-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 reuort 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 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: Gilbert T. Lee <br />7 <br />Permittee Name: Central Aggregates, Inc. _ <br />Address: P.O. Box 1877 <br />Phone Number: <br />Fax Number: <br />Rifle, CO 81650 <br />(970) 625-3598 <br />(970)625-4221 <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 />,.----~ <br />Signature of Corporate Officer, Owner, or Designee <br />~ -d~ -~`6 <br />Date <br />