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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />. f l <br />ANNUA?L FEtE an REJPORT REOUEST <br />I ask, LLC <br />2I-2002-087 <br />Mask Ranch Gravel Pit <br />a/?- <br />1cny <br />c CrcLiny! ' <br />.? uj J <br />,?re <br />ANNIVERSARY DATE: November 25, 2008 Divisu,r: -?? <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Archuleta <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-ari-d-during-the-3j receding-year,--iiev. -disturbances- that are-ar:tic patsd-tom -csur -- <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 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: Dennis Walker <br />Permittee Name: Mask, LLC <br />Address: <br /> <br />- Pegosa-Spr-ings; G9-8 .447 1 l fD? gait, q (0µ7 <br />Phone Number: .°( I' ?f- / a - "S "o ,,3-7 q :L4 <br />Fax Number: 43' f 4Q <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 />1?)11,41Z?11' <br />Signature of Corporate Officer, Owner, or Designee <br />L-)- '06 V' <br />Date