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<br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />. r? <br />ANNUAL EE and REPORT REQUEST <br />kFlorence Sand & Gravel <br />V?1-1992-051 <br />Florence Sand & Gravel Pit <br />August 11, 2008 <br />$$791.00 (Due on or before your anniversary date) <br />Fremont <br />RE <br />,%lUL 2 8 2008 <br />Divistoro o? , «clailration, <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 />:r?caamation_.accomplished to date and, during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will-be perforr?ied-during-the-co-.ninb 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 may 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 during 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: Delmer R. Rodarmel <br />Permittee Name: Florence Sand & Gravel /?/ Pi1?P ?4 .` lNCtdeL LLC <br />Address: 799 5th St <br />Penrose, CO 81240 <br />Phone Number: (719) 784-9255 <br />Fax Number: (719) 784-3241 <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 />2E L"d'. ;?Vvrl <br />Signature of Corporate Officer, Owner, r Designee <br />Date