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~. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~-y <br />q~~ <br />/ ANNUAL FEE and REPORT REQUEST <br />ashington County <br />~-1998-065 <br />Hayes Pit <br />September 18, 2006 <br />RECEIVED <br />/v SEP p 5 ?p06 <br />,/ Division ofRecl ~~ <br />Mining and ga <br />$281.00 (Due on or before your anniversary date) <br />Washington <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 your revised written annual report and annual resort maa 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 permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jesse J. Stackhouse <br />Permittee Name: Washington County <br />Address: 150 Ash <br />Akron, CO 80720 <br />Phone Number: (970) 345-2701 <br />Fax Number: (970) 345-2702 <br />.:~ ~ ~c~ ~ <br />S T <br />~D"7 ~ <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 />Si afore of Corpor e Officer, Owner, or Designee <br />~-/~ - ado 6 <br />Date <br />M:IPERMITW(ASTERDOCUMEMSiM-AF-00 <br />