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a k Qer <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNUAL FEE and REPORT REQUEST <br />Elam Construction, Inc. <br />M-1999-076 Z <br />Highway 50 Borrow Area No. 2 <br />b/ "Cev, <br />ANNIVERSARY DATE: August 5, 2009 Di*UG O 40019 jan Mip ot"?cta. <br />ANNUAL FEE DUE: $504.00 (Due on or before your anniversary date) 9 and Sa f,,*On <br />, <br />COUNTY: 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 shall <br />submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation <br />accomplished to date and during the preceding year, ne'w disturba nces that are anticipated to occur during the upcoming <br />year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the <br />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 & Fee <br />requirement is not met until we have received the following components: fee, report, and associated map. If no <br />new disturbances or reclamation have occurred during the previous year and no new changes to the previous <br />year's map are necessary, then no new map is required provided that the Operator shall state this in the Annual <br />Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary changes: <br />Permittee Contact: Stephen Kaspar <br />Permittee Name: Elam Construction, Inc. <br />Address: 556 Struthers Ave <br />Grand Junction, CO 81501-3826 <br />Phone Number: <br />Fax Number: <br />(970) 242-5370 <br />(970) 245-7716 <br />If you have additional comments and/or information that should be provided to the Division, please provide it below or <br />attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />(Signatu f Corpora e cer, Owner, or Designee <br />Date