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PERMITTEE NAME: <br />PERMIT NO.: V/ M-1991-133 APR 09 201 <br />OPERATION NAME: Valdez Gravel Mine `Jw Division <br />( cI "90a rift <br />ANNIVERSARY DATE: April 20, 2010 Adrrnng and S,h, <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Conejos <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 />-reclairratiow-,Tccornplis d- of-daate and-during tl-ie preceding year, new disturbances tli-are anticipated to`ocur <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 previous year'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: Demetrio Valdez <br />Permittee Name: Valle Escondido / ?ot, y" G?a; ;y, S/ow,r P 5'o Nd <br />Address: P.O. Box 84 v eitl a i" Tt'. 0JIre - o:- 1-eda,,na Tja/ <br />Conejos, CO 81129 / la /t i7hY c/?+?i <br />Phone Number: (719) 376-5873 J-13 Se°xPyr> s ) i ka la )a wi I / 6so <br />Fax Number: (719) 376-2451 _;I,;7 s SLy <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 />ignature of Corporate Of tcer, O r, or Designee <br />-? / ) q //") <br />Date <br />4c- ?F T- <br />AL FEE and REPORT RE UEST <br />j/Valle Escondido WCOMW