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RECEIVED <br />A? ? JUN 0 3 2009 <br />ANNUAL FEE and REPORT REQUEST <br />IDRw;s4Rn of Reclamation, <br />Mio,i,nq and Safety <br />PERMITTEE NAME: Grand County Department of Road and Bridge Y_ <br />PERMIT NO.: M-2008-008 <br />OPERATION NAME: Red Dirt Pit <br />ANNIVERSARY DATE: June 10, 2009 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: 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 <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 year's map are necessary, then no new map is required, 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 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: <br />Permittee Name <br />Ken E. Hayes <br />Grand County <br />Department of Road and Bridge <br />Address: <br />P.O. Box 9 <br />Grandby, CO 80446 <br />Phone Number: (970) 887-2123 <br />Fax Number: (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 orp t Officer, Owner, or Designee <br />4(0- /- og <br />Date <br />M:\PERMITI"TERDOCUMENTS\Ivl-AF-04