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AL FEE and REPORT REQUEST <br />PERMITTEE NAME: ./ Elam Construction, Inc. <br />PERMIT NO.: j M- 2000 -030 ✓ 30- 13 2 '3." <br />OPERATION NAME: AGRI -DLD Gravel Pit pi ,mk°n °t a sa e J n <br />r'+} mining <br />ANNIVERSARY DATE: July 5, 2011 .1 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: La Plata <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 />— — reclaarnatiorr date -- and during - the ` prece - ding =yeaar, nevi%tlrstt truces tharare amttci et'to <br />during the upcoming year, reclamation that will be performed during the 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 map 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 map 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. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Stephen Kaspar <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Elam Construction, Inc. <br />556 Struthers Ave <br />Grand Junction, CO 81501 -3826 <br />(970) 242 -5370 <br />a� der <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 />A O _ _...-...... , <br />Signa e o %orpo e..(.''' e <br />Date <br />7 s - a o // <br />wner, or Designee <br />