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ANNAL FEE and REPORT REOUEST <br />PERMITTEE NAME: ?'S?rague Scraper Service, Inc. <br />PERMIT NO.: 'M-2005-032 <br />OPERATION NAME: Sprague Scraper Service Pit <br />ANNIVERSARY DATE: August 16, 2008 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Washington <br />PSG nt-- <br />CEIVED <br />A-'AUG07K". <br />Division of Reclar: tic•?; <br />Mining and Safc.?, <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-axe_anticipated-to-occar--durarigthe-upcorning <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 may. If no <br />new disturbances or reclamation have occurred during the previous year and no new changes to the previous <br />vear's man are necessarv. then no new man is required, provided that the Operator shali_ 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: Jeffrey Sprague <br />Permittee Name: Sprague Scraper Service, Inc. <br />Address: 610 Ellis Ave. <br />Wray, CO 80758 <br />Phone Number: (970) 332-5807 <br />Fax Number: <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 />SignatukgV? rpo to Officer, Owner, or Designee <br />F- 1-a'K <br />Date