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~~~~P/ ~--~-~_„ ~_ <br />ANNUAL i'rEE and REPORT REQUEST " - -+~ <br />~f <br />a ~zluJ <br />PERMITTEE NAME: ~ Las Animas County Dive , , , <br />PERMIT NO.: ~ M-2001-015 ~~'~1n'ny crt; &zt~fy °n, <br />OPERATION NAME: Sandoval Land and Cattle Pit <br />ANNIVERSARY DATE: May 17, 2007 <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: Las Animas <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 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 year, if any. <br />Please attach vour revised written annual report and annual report moo 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 durinc the previous veer and no <br />new chances to the previous year's moo are necessary. then no new moo is repaired, provided that the <br />Operator shall state Phis 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: Phil Dorenkamp <br />PetTrtittee Name: Las Animas County <br />Address: 2000 N. Linden Ave. <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-4766 <br />Fax Number: (719) 846-0434 <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 />Owner, or Designee <br />Date <br />M:~PERMI'I\MASTERDOCUMENTSNd-AF-04 <br />