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<br />PERMITTEE NAME <br />PERMIT NO.: <br />/?? r, Aj 7- <br />ANNUAL FEE and REPORT REQUEST <br />'Brannan Sand & Gravel Company <br />?M-1980-183 <br /> <br />RECFIVE® <br />"DEC 2-4 2008 <br />OPERATION NAME: Pit 29 Division of Reclamation, <br />ANNIVERSARY DATE: January 8, 2009 Mining and Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Adams <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, reclamatioe that will be performed during-thc- coming year,-the dates for-the-be-ginning <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 chany-es to <br />the previous vear's man are necessarv. then no new man 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: Greg Gerganoff <br />Permittee Name: Brannan Sand & Gravel Company <br />Address: 2500 E. Brannan Way <br />Denver, CO 80229 ~y <br />Phone Number: (303) 534-1231 <br />Fax Number: (303) 534-1236 <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 if Corporate Officer, Owner, or Designee <br />Date