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~~ <br />~ /~ <br />~9- f t <br />ANNUAL FEE an >2EPORT REQUEST <br />PERMITTEE NAME: 'Chaffee County <br />PERMIT NO.: /M-1985-091 <br />OPERATION NAME: Salida Pit <br />ANNNERSARY DATE: June 30, 2007 <br />R~G~~9i~ <br />!/N p 4 ~' <br />o"'~;~n 1p~~ <br />r/~ftn; of kec~dn <br />n9 and Sa,~~ <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Chaffee <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 <br />operator shall submit the annual fee, a report and-map s7iowing the extenYof 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 vour revised written annual report and annual resort 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 chances 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Cheri Moore <br />Permittee Name: Chaffee County <br />Address: P.O. Box 699 ~~ <br />U <br />Salida, CO 81201 <br />Phone Number: <br />Fax Number: <br />(719)539-6961 <br />(719)530-9208 <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 />encl ® . <br />nature of Corporate Officer, Owner, or Designee <br />Date <br />MiPERMITMASTERDOCUMENTSM-AF-04 <br />