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'~~,~ ~L/ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUF,: <br />COUNTY: <br />/ANNUAL FEE and REPORT REQUEST <br />i/ Mullett Excavating, LLC <br />,/M-2000-115 <br />Mulletts Excavting Pit # 1 <br />January 29, 2007 <br />OZ~~~7 <br />~ ~r-• ,,.~ ~ a <br />.-.e~~~ <br />~~~Afd 312001 <br />/Divwbn o1 Reclamation, <br />hsmc?g and Safety <br />$$688.00 (Due on or before your anniversary date) <br />Las Animas <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date ofthe 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 yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. -- _ <br />Please attach vour revised written annual resort and annual renort map to this form. The Annual Report <br />Bc Fee requirement is not met until we have received the following components: fee, renort, and associated <br />maa. If no new disturbances or reclamation have occurred durinc the arevious veer and uo new chances to <br />the previous year's map are necessary, then no new map is required, urovided that the Ouerator shall state <br />this in the Annual Renort. Please note that an adequately labeled map that clearly delineates and includes the <br />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: CF.PR.contact_fnst_name CF.PRcontact last name <br />PermitteeName: CF.PR.company_name ~u.,ll~Pi-H ~'2rcci•ra`!-r~r,~ 1-~-G <br />Address: CF.PR.address 1 ~o i3~ 3si <br />_ _ _ _ _ __ CF.PR.city, CF.PR.state CF.PR.zip_code h1 ~S~-C-~l-~~y . fo ell l-i ~ <br />Phone Number: CF.PR.telephone_number ~ ~9 " ~& ~ - 1oS~, <br />Fax Number: ~ l °l - ~ 3 - ~ i S ~ <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 aze enclosed. <br />/f:!'~ <br />S~gna~orporate Officer, Owner, or Designee <br />/d- /d=-o6 <br />Date <br />