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ANNUAL FEE and REPORT REQUEST RECEIVED <br />f3" <br />7 ea 1'42011 <br />PERMITTEE NAME: / Rio Blanco County <br />PERMIT NO.: ✓ M- 1998 -054 i MI81011 et Re018111 Upfl, <br />OPERATION NAME: East Douglas Creek Gravel Pit Mining & Sat* <br />ANNIVERSARY DATE: October 5, 2011 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <br />._Accnrding_to_C.R_S 3_4,32_5,116 or C.R x,-34 -32 -11 ch-- year., -en rt- -ann versary- <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 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: David Morlan <br />Permittee Name: Rio Blanco County <br />Address: 570 2nd St. <br />Meeker, CO 81641 <br />Phone Number: (970) 878 -5601 <br />Fax Number: (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 />ignature of Corporate <br />ate <br />M:\PERMIT1MASTERDOCUMENTS\M -AF -04 <br />Owner, or Designee <br />i�F- R te' <br />