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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Permittee Contact;,. Toryy fr. Appel anz <br />/ � <br />Permittee Name: Base 'roducts <br />Address: 62339 W LaSalle Rd <br />Date <br />Phone Number: (970) 249 -3061 <br />Fax Number: <br />Sigma - of Co <br />$ ^ 7 -1/ <br />Montrose, CO 81403 <br />,qP 2P r" <br />AL FEE and REPORT REQUEST <br />d Products <br />/M- 1994 -053 <br />J Base Product Gravel Pit 1 <br />September 13, 2011 <br />$791.00 (Due on or before your anniversary date) <br />Montrose <br />f e Officer, 0 ' er, or Designee <br />RECEIVM <br />/ AUG 10 2011 <br />ip Division of Reclamation, <br />Mining and Safety <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 - and during the preceding year, ne w disturbances that are anticipated to occur <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 />man. 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 />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 />