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-~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />November 12, 2002 p <br />$688.00 (Due on or before your anniversary ~t~ategf Minerals and Geology <br />Kiowa <br />Kiowa County <br />M-1991-074 RECEIVED <br />Barnett Pit OCT 1 7 2002 <br />According [o 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 [tie 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 permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Rodney Hopkins <br />Permittee Name: <br />Address: <br />- Phone Number: <br />Fax Number: <br />Kiowa County <br />P.O. Box 100 <br />Eads, CO 81036 <br />(719) 438-5810 <br />(719) 438-532"1 <br />If you have additional comments and/or information that shoald 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 />r <br />:.~;.~ <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:IPERMITU4ASTERD000MENTStN7-AF04 <br />