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P, q7 =.J- Rp?- <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Webster Sand & Gravel L?4 C-11 <br />M-1981-235 <br />West Tennessee <br />April 22, 2009 <br />$791.00 (Due on or before your anniversary date) <br />Lake <br />RECEIVED <br />'-?JUN 012009 <br />Division of Reclamation, <br />Mining and Safety <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-M 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 may 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 may 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: Daryl R. Webster <br />Permittee Name: Webster Sand & Gravel <br />Address: P.O. Box 1834 <br /> <br />Colleyville, TX 76034-1834 <br />Phone Number: (719) 486-0427 <br />Fax Number: (719) 486-0427 <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 />7a? L"=.' <br />Signatur f rporate Officer, Owner, or Designee <br />o y/?-g/b? <br />Date