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I ~~~ '; ~` ., ,~. <br />ANNUAL FEE and REPORT REQUEST ~,~-r <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />a~ ~ ~ <br />Hocker Construction, LLP <br />M-2004-063 `~ <br />Hocker Gravel Pit <br />April 11, 2009 <br />,/ APR ~ ~ 2009 <br />f.:" <br />$791.00 (Due on or before your anniversary date) <br />La Plata <br /> <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-repor-t--and--map-showing=the-extent-of~current=disturbances-to-affeeted~lamrl-------- <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 />man. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary. then no new map is required, provided that the Operator shall state <br />this in the Annualthis in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Roy Hocker <br />Permittee Name: Hocker Construction, LLP <br />Address: P O Box 627 <br />Phone Number: <br />Fax Number: <br />Ignacio, CO 81137 <br />(970)563-9533 <br />(970) 563-4238 <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 o orate Officer, Owner, or Designee <br />~a~ <br />Date <br />