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4?p * UF <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />Grand County <br />M-1984-156 <br />Grand Cnty No 201 aka Scholl Gravel Pit <br />May 29, 2009 <br /> <br />APR 2 r 2009 v <br />$791.00 (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 theanniversary date of the permit, an _ <br />operator shall submit the annual fee, a -report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to _ <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous vear's map are necessarv. then no new man is reauired, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Ken Haynes <br />Permittee Name: Grand County <br />Address: 467 E. Topaz Ave. <br />P.O. Box 9 <br />Phone Number: <br />Fax Number: <br />Granby, CO 80446 <br />(970) 887-2123 <br />(970) 887-3168 <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 <br />enclose . <br />Signature of Corpo Officer, Owner, or Designee <br />h1 Zo 20d <br />Date <br />M:\PER vHTOAASTERDOCUMENTS\N4-AF-04