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ECOD <br />A'? ? JU.N 0 20 i 0 <br />ANNUAL FEE and REPORT REOUEST <br />Division of R@ciaMptiaP, <br />Mfni?O ? ?a#e#y <br />PERMITTEE NAME: YGrand County Department of Road and Bridge <br />PERMIT NO.: v//M-2008-008 <br />OPERATION NAME: Red Dirt Pit <br />ANNIVERSARY DATE: June 10, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Grand <br />_-According According to C.R.S._ 34-32.5416_or C _R.S. 34_32-116,_each .yearron 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 and during the preceding year, new disturbances that are 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 map 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 changes to the previous year's map are necessary, 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: Ken E. Kem NA yNE-5 <br />Permittee Name: Grand County Department of Road and Bridge <br />Address: <br />P.O. Box 9 <br />Eiimtdb, CO 80446 ?s1RR1-i by, 0-0 goggLp <br />Phone Number: (970) 887-2123 <br />Fax Number: (970) 887-3168 <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 <br />enclosed. <br />Signature of Corporate O r, Owner, or Designee <br />i <br />b <br />Date o <br />'5- ff M:\PERMIIIMASTERDOCUMENTS\M-AF-04 <br />