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~- ~~ T <br />ANNUAL FEL'and REPORT REQUEST <br /> <br />_ AUG ,: 2001 <br />D(hlL~l,~, ~., nCCttlOiu(IOn, <br />r.°.ining and Safety <br />PERMITTEE NAME: l Wallace F. Burns <br />PERMIT NO.: /14I-2001-070 <br />/ <br />OPERATION NAME: Florence Pit <br />ANNIVERSARY DATE: August 23, 2007 <br />ANNUAL FEE DUE: $259.00 (Due on or before your anniversary date) <br />COUNTY: Teller <br /> <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'suUmifthe annuaYfee; a report and map showm`g "the extent o rrent'dts r antes 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 renort and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, renort, and <br />associated map. If no new disturbances or reclamation have occurred durinti the arevious vear and no <br />new chanties to the previous year's map are necessary, then no new map is required, arovided 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: Wallace F. Burtis <br />Permittee Name: <br />Address: <br />Phone Number: <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 <br />en to d. <br />.~~~ <br />Signature of Corporate Officer, caner, or Designee <br />-) ~- ' O <br />Date <br />Wallace F. Burns <br />66 Dartmouth Ave. <br />Pueblo, CO 81005 <br />(719)566-1669 <br />M:IPERMI'11MAS7ERDOCIJMENTS/M-AF-02.DOC <br />