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A? + RPT <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Tri County Gravel 1/ <br />PERMIT NO.: M-1977-205 <br />OPERATION NAME: Tri-County Gravel <br />ANNIVERSARY DATE: November 29, 2008 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Delta <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 />reclamation accomplished- to-date-and- during-the preceding-year, new-disturbances that-are--anticipated to 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 report 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 during the previous year and no new changes to <br />the previous vear's map are necessarv. 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: Richard E. Curry <br />Permittee Name <br />Address: <br />Phone Number: <br />Fax Number: <br />Tri County Gravel <br />P.O. Box 566 <br />--Hotchkiss, CO 81419 - - - - - - - - <br />(970) 872-3545 <br />(970) 872-3792 <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 />Signature ?of Corporate Officer, Owner, or Designee <br />/ ?p 09 <br />Date