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AN AL FEE and REPORT REQUEST <br />PERMITTEE NAME: / Kiowa County <br />PERMIT NO.: t'`M-1991-073 <br />OPERATION NAME: Ferris Pit <br />ANNPJERSARY DATE: July 12, 2007 <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: Cheyenne <br /> <br />RECEfVED <br />~IJUN 14 2007 <br />pryision of Reclamation, <br />Mining and Safety <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 ~ it,_an_ _ __ _ <br />opeiator 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 yeaz, 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 durine the previous year and no <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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Rick Spady <br />Permittee Name: Kiowa County <br />Address: P.O. Box 100 <br />Phone Number: <br />Fax Number: <br />Eads, CO 81036 <br />(719) 438-5810 <br />(719) 438-5327 <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 a]ong with your written report and map. Annual Report instructions are <br />enclosed. <br />Signafure of orpo~tcer, Owner, or Designee <br />6-~__ o~ <br />Date <br />M:~PERMITNIASTERD000MENTSUr-AF-04 <br />