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AP + Rem <br />ANNUAL FEE and REPORT RE UEST <br />PERMITTEE NAME: Ace West Trucking, Inc. iipu <br />PERMIT NO.: /M-1999-007 ? APR 2 6 2010 <br />OPERATION NAME: North River Gravel Pit Extension ?Ar Division <br />I?tfnino and Safety <br />ANNIVERSARY DATE: April 28, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <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 />_ durfng 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 durinS the previous year and no new changes to <br />the previous year's map are necessary, then no new may 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: Donald O. Rooks, Jr. <br />Do...-+-.XT.mo- ArPWPct Tnulcinv Tn(-, . 17), n,u / 4S <br />Address: 15672 Hwy. 64 /?L 1 C %? P ?am j <br />P.O. Box 250 Cn n?o <br />Rangely, CO 81648 <br />Phone Number: (970) 675-2753 <br />Fax Number: (970) 675-2702 <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 />-- a rij -.,71,a- :i?'A- <br />Signaturrrysrate Officer, Owner, or Designee <br />Date