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<br /> 19F <br /> <br /> AL FEE and REPORT REOUEST <br /> <br />PERMITTEE NAME: stern Gravel, Inc. <br />PERMIT NO.: V _I 92-102 C2WEID <br />OPERATION NAME: South D-20 Pit 20??? E8 2 <br />5 <br />ANNIVERSARY DATE: February 24, 2010 5 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary datePivision of Reclamation, <br /> Mining & Safety <br />COUNTY: Montrose 40 <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, 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 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 Drevious vear's map are necessarv, 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: JuO DkVincentis <br />Permittee Name: Wstenfflravel. Inc. <br />Address: 3001 W Townsend Ave. <br />Montrose, CO 8140.1 <br />Phone Number: (970) 249-2431 <br />Fax Number: (970) 249-0590 <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 />7ture rorporate Officer, Owner, or Designee <br />Date