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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />A'?: * 0 -r <br />ANNUAL FEE and REPORT REOUEST <br />V?Rio Blanco County <br />M-1999-040 <br />Red Wash Gravel Pit <br />May 17, 2011 <br />owir-O <br />-0011 <br />??l?31?{vr? Fy'?9t1d ???d? <br />$323.00 (Due on or before your anniversary date) <br />Rio Blanco <br />-According--to-C.R.S. 34-32.5-116 or C.R.S:- 34-32-11-6,-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 />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 may. If no new disturbances or reclamation have occurred during the previous year and no <br />new chances to the previous vear's map are necessary, then no new may 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: David P. Morlan <br />Permittee Name: Rio Blanco County <br />Address: 570 2nd St. <br />Meeker, CO 81641 <br />Phone Number <br />Fax Number: <br />(970) 878-9590 <br />(970) 878-3396 <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 />gnature of Corp ate fficer, Owner, or Designee <br />Date <br />M:\PERMrr\tM TERDOCUMENTS\ 4-AF-04