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fl?nnv.o? ?°?? <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />San Juan County <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" a`nd during the preceding year, new disturthat ae 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 vour 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 chances to the previous vear's map are necessarv. 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 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: Louis K. Girodo <br />Permittee Name <br />Address: <br />1512 Greene St <br />P.O. Box 466 <br />ANNUAL FEE and REPORT REQUEST <br />San Juan County <br />M-1990-070 <br />Eureka Gravel Pit <br />RECEIVED <br />t--' AUG 3 1200g <br />?01 Divisien of Reeclamation, <br />Mining and Safety <br />July 5, 2009 _ <br />$323.00 (Due on or before your anniversary date) IX,j <br />San Juan <br />Silverton, CO 81433 <br />Phone Number: (970) 387-5772 <br />Fax Number: (970) 387-5019 <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 or Owner <br />4jq11s_ '(0, d <br />Date