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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />nP *- R#r <br />ANNUAL FEE and REPORT RE UEST <br />Valle Escondido <br />/ M-1991-133 <br />Valdez Gravel Mine <br />April 20, 2011 <br />RECEIVED <br />,/ APR 19 ZQ11 <br />v? Division of RectamaUon, <br />Mining & Safety <br />$791.00 (Due on or before your anniversary date) <br />Conejos <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; reclarn-awo that-wrlt'be7performcd-during-tire-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 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 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..Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Demetrio Valdez <br />Permittee Name: Valle Escondido f ' pn0/ 0 <br />Address: P.O. Box 84 h a 4- r /gm ;a %ieH /i?W <br />g 1''e X90 ?_%" L??, ,/1?0?) fC?al?P?f <br />Conejos, CO 81129 W? in 2,,V& <br />Phone Number: (719) 376-5873 5C) a f -17 4 0 a , SC i <br />Fax Number: (719) 376-2451 o k, <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 t is form along with your written report and map. Annual Report instructions are enclosed. <br />ignature o7jirl o O fficer, Owner, or esi'gnee <br />1 <br />Date