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;_ ~. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />RECEIVED <br />//,((~~~~ ~ Z <br />NUA~FEE'nd"REPORT REQUEST <br />Park County <br />M-1980-252 <br />A ril 1, 2007 nista~ or ~~..,~„ ..,n, <br />P Mining and ~arery <br />$688.00 (Due on or before your anniversary date) <br />Park <br />According to C.R.S. 34-32.5-I 16 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 showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding yeaz, new disturbances that are anticipated to <br />occur during the upcoming yeaz, 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 yeaz, if any. <br />Please attach your revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Coniact: David Kintz <br />Permittee Name: Park County <br />Address: P.O. Box 147 <br />AN <br />Jefferson Flats Pit <br />Fairplay.CO 80440 <br />Phone Number: (719) 836-4280 <br />Fax Number: (719) 836-4275 <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 />d <br />Signature of Corporate Off ce Owner, or Designee <br />,~- /~ -y 7 <br />Date <br />MARL 6 2007 <br />Divisr..;,i of Reclamation, <br />Mining and Safety <br />REC'~ " } <br />i MAR ~ 6 ~ ..a <br /> <br />