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a <br />r _ J <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />//~~~~ti `~- / <br />ANNUAL FEE and REPORT REQUEST <br />'Kit Carson County <br />M 1982-054 <br />Eberhart Pit <br />June 24, 2007 <br />e'f~'~°tC~l p~~ <br />~ 1 `~ Z007 <br />~D +'tsion of Recl <br />Mining and ga e~ on <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Kit Carson <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 [he annual fee, a report and map showing the extent of cunent 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 renort and annual renort moo to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, renort, and <br />associated map. If no new disturbances or reclamation have occurred durinti the previous year and no <br />new chanties to the previous year's moo 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 />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />L <br />Kit Carson County <br />P.O. Box 160 <br />Burlington, CO 80807 <br />Phone Number: (719) 346-8139 <br />Fax Number: (7l9) 346-7242 <br />('/-1~2UL ~2 (% Z <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 />enc1~G~'~ ~ ~/G~~ <br />Signatur''~e,of4C,orporate Officer~,7~~w,~nerZor Designee <br />Date 0 <br />M:~PERMITMASTERD000MENTS\M-AF-04 <br />