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09/21/2010 09:04 <br /> <br /> <br />P RMIT' "EE NAME: <br />PERMIT NO.: <br />OPERATION NAME; <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />ANNUAL ME and REPORT RE-OVEST <br />Montezuma County <br />N0.697 D03 <br />/ M-1999-077 . ti <br />Ormiston Gravel Pit L/ SEP 1 2010 <br />October 25, 2018 L" Dv"n &j r3Sc L" $791.00 (Due on or before your anniversary date) <br />COUNTY. Dolores <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 <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 />Pleas= Four 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: feet rMort,j and <br />associated map. If no new disturbances or reclamation have occurred during he 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 Retort. Please note that are 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: Lloyd Everett <br />Permittee Name: Montezuma County <br />Address: 1680 North Dolores Road <br />Cortez, CO 81321 <br />Phone Number: (970) 56S-8666 <br />Fax Number: (970) 565-8252 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below o; attach it to this form. along with your written report and map. Annual Report instructions are <br />re Corporate Officer, Owner, or Designee <br />00 <br />r <br />Date <br />