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ANNUAL FEE and REPORT REQUEST <br /> RECEIVED <br />PERMTTTEE NAME: Elbert County NOV 0 6 2007 <br />PERMIT NO.: M-1985-129 Division of Reclamatlon, <br />OPERATION NAME: Elbert County Pit Mining and Salety <br />ANNNERSARY DATE: November 25, 2007 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Elbert <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 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 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 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 changes to the previous year's map are necessary, then no new map is required. provided that the <br />Ouerator 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 contactinformafion. Please verify and make any necessary <br />changes: <br />Permittee Contact: Rick Manyik <br />Permittee Name: Elbert County <br />Address: P.O. Box 116 <br />Phone Number: <br />Fax Number: <br />Kiowa, CO 80117 <br />(303) 621-3157 <br />(303) 621-3159 <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 />enclose ~ // <br />Signature of Corpdrate Offid~r, Owner, or Designee <br />Date <br />M:~PERMI7~MASTERDOCUMENTSNI-AF-04 <br />