2007-01-23_REPORT - M2004057 (2)

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0~~ PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: ~ ANNUAL FEE and REPORTREOUEST ^~~~^~~~~ '/ BBent County v M-2004-057 Reyher Trusts Pit January 27, 2007 JAN 2 3 2001 Division of Reclamation, Mining and Safety $$688.00 (Due on or before your anniversary date) Bent ~~ Ol-a3'D~/ 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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the upcoming yeaz, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the date active operations ceased for the year, if any. Please attach your revised written annual report and annual report map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated maa. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to the urevious year's maa are necessary, then no new map is required, provided that the Operator shall state this in the Annual Reuort. Please note that an adequately labeled map that clearly delineates and includes the above elements may since for a written report. Division records indicate the following petmittee contact information. Please verify and make any necessary changes: Pennittee Contact: Gary L. Pritchard Permittee Name: Bent County Address: 725 Bent Ave - - - P.O.-Box 350 -- - - Las Animas, CO 81054-0350 Phone Number: (719) 456-2223 Fax Number: (719) 456-0375 If you have additional comments and/or information that should be provided to the Division, please provide it below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. Signature of Corporate Officer, Owner, or Designee O I - ~ .~ - ~.ot) ~i' Date M:~PERMI7UTASTERDOCUMENTSVvf-AF-04