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ANNUAL FEE and REPORT RE UEST <br />ECEIVED <br />PERMITTEE NAME: City of Lamar DEC 1; 3 2D01 <br />PERMIT NO.: M-1984-154 <br />Diuisian of Minerals and Geology <br />OPERATION NAME: Well Field Pit <br />ANNP/ERSARY DATE: December 10, 2002 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Prowers <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 shgwing the extent of current disturbances to affected <br />anr- rtTeclama ton accompns a to ate an unng t e prece mg year, new dtsturbances that are anticipated [o <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 your revised written annual report and annual report map to this form. Please trote that err <br />adequately labeled map that clearly delineates and Includes the above elements may suffice for a wr/tten <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Patrick Mason <br />Permittee Name: City of Lamar <br />Address: 102 E. Parmenter St. <br />Lamar, CO 81052-3239 <br />Phone Number: (719) 336-4495 <br />Fax Number: (719) 336-4404 <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 />~Z~ <br />Signature of Corporate Officer, Owner, or Designee <br />/2- 3-~z <br />Dale <br />M:IPERMITIMASTERD000MENTS~M-AF-W <br />