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,, <br />11 . PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />AR Ar a P? <br />ANNUAL FEE and REPORT REOUEST <br />Louisiana Land and Gravel Company, )VECLVIIVED <br />M-2000-049 -,/ APP 11201, <br />Angie Pit Division oriveciaM <br />April 9, 2011 Mining $ Sarety on, <br />$791.00 (Due on or before your anniversary date) <br />Montrose <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 />during the upcoming year, reclamation that will be performed during the comingLyear, the dates for the?beginnpg, <br />-- <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 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 />ma . If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous vear's map are necessarv. then no new man is reauired, 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: Michael A. DeJohn <br />Permittee Name: Louisiana Land and Gravel Company, LLC <br />Address: P.O. Box 8419 <br />Clinton, LA 70722 <br />Phone Number: (225) 683-3358 <br />Fax Number: (225) 683-3802 <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 />Signature of Corpo a Officer, Owner, or Designee <br />3IzclI <br />Date