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-N + V-6 I <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Montezuma County <br />PERMIT NO.: M-1999-077 c/ SEP `j 9 nun <br />OPERATION NAME: Ormiston Gravel Pit Division of k<eciarnation, <br />ANNIVERSARY DATE: October 25, 2008 Ining and Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Dolores <br />--According-to-C-.R:S 334-32.5-116-or-C-R.S 3-4-32-.1-1-6;-each year-,-on-the-anniversary-date-of--the-permit,-an- <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous vear's map are necessarv, then no new map is reauired. provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Lloyd Everett <br />Permittee Name: Montezuma County <br />Address: <br />Phone Number: <br />Fax Number: <br />1680 North Highway 145 <br />Cortez, CO 81321 <br />(970) 565-8666 <br />(970) 565-8252 <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 <br />enclo d. <br />Se2 MW <br />S e ature f orporate Officer, Owner, or Designee <br />g 1 10 / 0 <br />Date <br />M:IPERMIT1MASTERDOCUMENTS\M-AF-04