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ANNUAL FEE and REPORT REQUEST ~~~~~® <br />~JUL 312006 <br />PERMITTEE NAME: / John M. Everitt ' <br />/DlYlslon of Minerals and Geology <br />PERMIT NO.: ~ M-2004-037 <br />OPERATION NAME: Everitt Pit <br />ANNNERSARY DATE: August 3, 2006 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COLIN'I'Y: Phillips <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 map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: John M. Everitt <br />Permittee Name: John M. Everitt <br />Address: 24274 CR 17 <br /> Haxtun, CO 80731 <br /> <br />- Phone-Number:- 4 <br />(470)-774-9508 -~ /' ~7U ~L~" ~ 1--7~~,- G~j - - <br />Fax Number: <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 />enclosed. <br />Si tore of Corporate Officer, Owner, or Designee <br />~-17-a~ <br />Date <br />M:~PERMITNfASTERDOCUMENTSUI-AF-04 <br />