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f?-p y- R T_ <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Grand County Department of Road & Bridge <br />PERMIT NO.: M-2006-029 <br />OPERATION NAME: South Fork Gravel Pit (aka Williams Fork) <br />ANNIVERSARY DATE: August 28, 2009 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Grand <br />RECEIVED <br />JUL ? o zoos <br />DVision 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 -aecomplished-to-date-and- during -the-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: Bill Clark <br />Permittee Name: Grand <br />Address: <br />P.O. Box 9 <br />County Department of Road & Bridge <br />Granby, CO 80446 <br />Phone Number: (9?6)-$8?-23i3- <br />Fax Number: (970) 887-3168 <br />C9??\ ?32- 2123 <br />J <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 />Signature of Corporate Officer, Owner, or Designee <br />? ? /? 2Dd p <br />Date