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<br />a~ ~- RPT <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Delta County <br />M-1978-172 <br />Antelope Hill Pit <br />October 26, 2007 <br />~G,E~~I~~ ~/ <br />R 25 Zoos .~ <br />0~ at Q d 8~ °~ n' <br />ptV1M ~\n9 <br />$$791.00 (Due on or before your anniversary date) <br />Delta <br />- According-to C:R.S~4-323-1-16 or-C.R.S. 34-32-1-16, each-year, on_the anniversary date o~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 year, new disturbances that are anticipated to <br />occur during the upcoming yeaz, 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. 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 durinc the previous year and no <br />new chances to the previous year's mao 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 />de/ineates 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: Larry Record <br />Permittee Name: Delta County <br />Address: 501 Palmer St., Ste. 227 <br />Phone Number: <br />Fax Number: <br />aye ad <br />below or 1 <br />Date <br />Delta, CO 81416 <br />(970) 874-2100 <br />(970) 874-2114 <br />ion~co nt <br />it to tbi~ <br />information that should be provided to the Division, please provide it <br />with your written report and map. Annual Report instructions are <br />or <br />M iPERMITVMASTERDOCUMENTSNR-AF-09 <br />