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'? n A <br />AfL1r <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: one Sand and Gravel, LLC RECEIVED <br />PERMIT NO.: 2004-026 <br />AUG 2 .2009 <br />OPERATION NAME: Leone Gravel Pit <br />[)ivlsitan oY l:C?,clamation, <br />ANNIVERSARY DATE: August 25, 2009 ,q!yj MInIng and Sal--'.- <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Las Animas <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 disturbances that are anticipated to occur <br />during the upcoming year,rcclamation 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 map 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 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: Frank L. Leone <br />Permittee Name: Leone Sand and Gravel, LLC <br />Address: 502 S. Walnut St. <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-4170 <br />Fax Number: (719) 846-0605 <br />Leong Sand 4- &rcj,( 40- <br />'foa f,- 171Aftj 67' <br />-rK #41,0 A 0 Cn 5< tog -2 <br />-SAM&- <br />SA-m= <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 Offic Owner, or Designee <br />Zr I - d S <br />Date