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17 <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Base Products RECEIVED <br />PERMIT NO.: M-1994-053 ? AUG 13 7OOq <br />OPERATION NAME: Base Product Gravel Pit 1 Division of Reclamation, <br />ANNIVERSARY DATE: September 13, 2009 Mining and Safet <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Montrose <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-the=preceding year,-new-distur-banes-that are-anticipated-to-ocekr <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 man to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />man. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous vear's map 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: Tony F. Appelhanz <br />Permittee Name: Base Products <br />Address: 62339 W LaSalle Rd <br />Montrose, CO 8140)(yn s ?6, <br />Phone Number: (970) 249-3061 <br />Fax Number: <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 />d <br />Signatur of Corpo fficer, Owner, r Designee <br />Date