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1'"- <br />~~ ~ RPT <br />PERMTTTEE NAME: <br />PERMTI' NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COLJN"I'Y: <br />ANNUAL FEE and REPORT REQUEST <br />Montezuma County `~~ <br />M-1978-107 / <br />Tozer Pit <br />November 2, 2007 <br />RECEIVEp <br />OCT 2 22001 <br />Division of Reclamation, / <br />Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Montezuma <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversazy 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 year, reclamation that will be performed during the coming yeaz, 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 report 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 vear 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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lloyd Everett <br />Permittee Name: Montezuma County <br />Address: 1680 North Highway 145 ~ Co~~ ~r ~-~.. l7o Ir~r e5 o A d <br />Cortez, CO 81321 <br />Phone Number: (970) 565-8666 <br />Fax Number: (970) 565-8252 <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 <br />enclosed.) <br />Sign~ttue df Cdtpor'afe Officer, Owner, or Designee <br />1°l~d 7 <br />Date <br />M:NERMITMASTERD000MENTSVN.AF-04 <br />