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*- CkK <br />ANNUAL FEE and REPORT REOUEST <br />6 <br />PERMITTEE NAME: Grand County Department of Road and Bridge <br />PERMIT NO.: /M-2008-008 <br />OPERATION NAME: Red Dirt Pit <br />ANNIVERSARY DATE: June 10, 2011 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Grand <br />?RECEIV! <br />MAY 23 2011 <br />J Y Divfmon or Reclamation, <br />Mining and Safety <br />-_According to GR 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 />Please attach vour revised written annual report and annual report may to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year'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: Ken E. Haynes <br />Permittee Name: Grand County Department of Road and Bridge <br />Address: P.O. Box 9 <br />Granby, CO 80446 <br />Phone Number: (970) 887-2123 <br />Fax Number: (970) 887-3168 <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 thi form along with your written report and map. Annual Report instructions are <br />enclosed. l <br />%--0' <br />Signature of Corpora Office , wner, or Designee <br />S• /5• L01? <br />Date <br />M:\PERMIT\MASTERDOCUMENTS\M-AF-04