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~ iii iiiiiiiiiiiiiiii <br />ANNUAL FEE and REPORT REQUEST <br />PERMfI"I'EE NAME: Park County <br />PERMIT NO.: M-1980.014 <br />OPERATION NAME: Eleven Mile Pit <br />ANNIVERSARY DATE: Aprll 1, 2001 <br />ANNUAL FEE: 5688.00 (Dae on or before anniveraary dAte) <br />COUNTY: Park <br />RECEIVED <br />MAR 10 2001 <br />Division a/Minerals and Geology <br />According to C.R.S. 34-32.5 or C.R.S. 34-32-116, each year. On the anniversary date of <br />the perntit, an operator shall submit the ammual fee, a report and map showing the extent <br />of current disturbances to affected land, reclamation accomplished to date and during the <br />preceding yeaz, new disturbances that are anticipated to occur during the upcoming year, <br />the dates for the beginning of active operations, and the date active operations ceased for <br />the year, if any. <br />note that an adequately labeled map that clearly delineates and includes <br />the above elements may sufJSce for a written report. <br />Division records indicate the following permittee contact information. Please verify and <br />make any necessary changes: <br />Pennittee Contact: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />~OU~ ~'~ITI-4 <br />Yii2K CoyAlT~l <br />• O. X 1~1 <br />Fa, RP ~(,rCn,, X0440 <br />7/ 9 fi3~ - 270 <br />714 R3~ - x.75 <br />If you have additional comments and/or information that should be provided to the <br />Division, please provide it below or attach it to this form along with your written report <br />and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer or Owner <br />Date <br />