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~ _ ~~t <br />ANNUAL F'EE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />//Grand County <br />/M-1977-256 <br />Benson Pit <br />March 23, 2007 <br />. ~~.r.e "" ",~1 <br />I`y , ~ ~ r <br />fE3 7 % 2CQ7 <br />Divie:on cr " !rra_~iion, <br />~Y;inirn~ c ud y:~ic,ty <br />$$688.00 (Due on or before your anniversary date) <br />Grand <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, 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 />1and,-reclamation accomplished-to-date and during the<preceding_year,~tew disturbances that.aze.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 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 man. If no new disturbances or reclamation have occurred durinc the previous year and no <br />new chances to the previous year's map 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 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: <br />Permittee Name: <br />Address: <br />Ken Haynes <br />Grand County <br />467 E. Topaz Ave. <br />P.O. Box 9 <br />Granby, CO 80446 <br />Phone Number: (970) 887-2123 <br />Fax Number: (970) 887-3168 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it o this form along with your written report and map. Annual Report instructions are <br />enclose <br />Signature of Corporat ~cer, Owner, or Designee <br />Z - 2 3-- zv-a ~ <br />Date <br />M:~PERMITN1ASr8RDOCUMENTSWf-AF-04 <br />