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PERMITTEE NAME: ' Elbert County GEIVF.r <br />PERMIT NO.: 'M- 2001 -010 AUG 0 4 2011 <br />vision ur, .Ld;j+i,),C, v,r, <br />OPERATION NAME: Allison Gravel Pit Mining and ; dety <br />ANNIVERSARY DATE: August 14, 2011 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Elbert <br />_ _According _to C.R.S. 34- 32.5 -11_6 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 th tent 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 your 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 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 map 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: Lynne Eschbach <br />Permittee Name: Elbert County <br />Address: P.O. Box 116 <br />Phone Number: <br />Fax Number: <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 />PA3LC`t <br />enclosed. <br />Signa � re of Corporate Officer, Owner, or Designee <br />Date <br />Kiowa, CO _80117 <br />(303) 621 -3157 <br />(303) 621 -3159 <br />M:IPERMITIMASTERDOCT 7MENTS\M -AF -04 <br />AN UAL FEE and REP RT REQUEST <br />