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SIP *- (an- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Yust Ranch <br />M-2000-014 <br />Yust Ranch Gravel Pit <br />May 22, 2009 <br />CEI'V 1) <br />APR 15 2000 '-? <br />Division or Reclamation, !? <br />II?&g and Safety V/1 <br />$323.00 (Due on or before your anniversary date) <br />Grand <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 />durin?tFie ugcomirigyear, recctaination-thi fwill-be -performed-dugitrgthe-comingyear, -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 year's map are necessary, 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: Jim Yust rr -- <br />?QStCt/?tpD lKWiSlAYO2?tt <br />Permittee Name: Yust Ranch <br />Address: P.O. Box 246 <br />881 Grand County 1 <br />Kremmling, CO 80459 <br />Phone Number: (970) 724-3578 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attac is ith your written report and map. Annual Report instructions are enclosed. <br />C <br />Signature of Corporate Of cer, Owner, or Designee <br />9 - 1.1, -D?, <br />Date