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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />r, in *- V 7- <br />ANNUAL FEE and REPORT RE{O?U-EST <br />Ephemeral Resources, LLC ? <br />M-2002-046 <br />D Road Gravel Pit <br />April 14, 2009 <br />ciet f ') <br />APR 2 7 2009 c? <br />Dry 'on or r`ecl.?rMation, <br />14;69 and Safety <br />$791.00 (Due on or before your anniversary date) <br />Mesa <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--aceompiirsh-e&-to-date-andziurmrthd preceding _yeaT,-newziisturbances= that are= antiiciplt_ed-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 />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: Mark Gardner <br />Permittee Name: Ephemeral Resources, LLC <br />Address: 225 S 7th St <br />Grand Junction, CO 81501 <br />Phone Number: (970) 242-5370 <br />Fax Number: (970) 245-7716 <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 />za'a of Corporate Off er, Owner, or esignee <br />' <br />-/-//- 20-° <br />Date <br />SS-6 S 7-- c<, Z`1icr.s 4v e