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� EST l <br />AN AT, FEE and REPORT O <br />PERMITTEE NAME: Tr Cr ig J. Walker Revocable Trust <br />PERMIT NO.: ( 1 -2003 -068 <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Mary's Mountain Gravel Pit <br />February 24, 2012 <br />$323.00 (Due on or before your anniversary date) <br />Huerfano <br />Y <br />4t, <br />F � <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 date and during the preceding year, new 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 />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: Craig J. Walker <br />Permittee Name: Craig J. Walker Revocable Trust <br />Address: 420 E. 58th Ave., Ste. 200 <br />Denver, CO 80216 <br />Phone Number: (303) 292 -5537 <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 enclosed. <br />— <br />Signature o f oipc)r 1 f cer, Owner, or Designee <br />4 )./ 9- 1 / <br />Date <br />There is no exposed ground water <br />at this site. <br />fc <br />