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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Aiz" q- U-r <br />ANNUAL FEE and REPORT REOUEST <br />i <br />Thomas F & Ginger L Latham <br />M-1981-058 <br />DeBeque Gravel Pit <br />September 7, 2010 <br />$791.00 (Due on or before your anniversary date) <br />Mesa <br />EI C ARVONP <br />-"?SEP 0: '2010 <br />Ow;ori cr Rt d--ivrwicn, <br />Knirg 2nd ,qty <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 />durin the upcoming year reclamation that will be perforgled during_ he,_coining:y_ear,-the_dates-for-the.beginning-_ <br />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 may 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 chances 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: Thomas F. Latham <br />Permittee Name: Thomas F & Ginger L Latham <br />Address: P.O. Box 66 <br />DeBeque, CO 81630 <br />Phone Number: (970) 283-5633 <br />Fax Number: <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 />C• <br />Sign J' re of Corporate Officer Owner, or Designee <br />3o -- aol4 <br />Date