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<br /> <br /> ANNUAL FEE and REPORT REOUEST <br /> 0/ <br />PERMITTEE NAME: Dilleys Sand & Gravel <br />PERMIT NO.: M-1986-105 ? <br />OPERATION NAME: Vondy Pit <br />ANNIVERSARY DATE: August 29, 2008 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Morgan <br />RECEiva® <br />AUG o 6 zoos L/ <br />Division of Keclamation, <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 shall <br />submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation <br />accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the upcoming <br />- - -- year, reclamation that-will-be performed-during the coming year,- the-dates-for the-beginning-of active operations,-and the;-- <br />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 & Fee <br />requirement is not met until we have received the following components: fee, report, and associated map. If no <br />new disturbances or reclamation have occurred during the previous year and no new changes to the previous <br />vear's map are necessarv. then no new map is reauired. provided that the Operator shall state this in the Annual <br />Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary changes: <br />Permittee Contact: Vernon Dilley <br />Permittee Name: Dilleys Sand & Gravel <br />Address: 1914 Edmunds St. <br />P.O. Box 125 <br />Brush, CO 80723 <br />Phone Number: (970) 842-2810 <br />Fax Number: (970) 842-2284 <br />If you have additional comments and/or information that should be provided to the Division, please provide it below or <br />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 esignee <br />/7/- o?-7' <br />Date