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` ' RECEIVE®~ <br />MAY 2 4 2pp2 <br />ANNUAL FEE and REPORT REQUEST Division of Minerals and Geology <br />PERMITTEE NAME: Chaffee County <br />PERMIT NO.: M-1978-192 <br />OPERATION NAME: Pit No 6 <br />--- <br /> <br />ANNIVERSARY DATE: ~ <br />~ <br />t~ne 30,, 200 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Chaffee <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 lnap_show~ng [he extent_of Curren[_disturbances_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 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 pemtittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Cheri Moore <br />Permittee Name: Chaffee County <br />Address: P.O. Box 699 <br />Phone Number: <br />Fax Number: <br />Salida, CO 81201 <br />(719)539-6961 <br />(719)539-7442 <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 />Signatu o rporate Officer or Owner <br />Dale <br />M:~PERMI7NIASTERDOCIIMENT5NI-AF-04 <br />