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~'~ <br />V ANNUAL FEE and REPORT REQUEST <br />PERMTI"fEE NAME: ~ Charles W Houchin <br />PERMff NO.: /M-1980-249 <br />OPERATION NAME: Houchin Gravel Pit <br />ANNIVERSARY DATE: February 4, 2007 <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: EI Paso <br />of as~~ I <br />R.~~Fpl~-.-® <br />~~ JAN 251001 <br />'~ Division o f qp <br />Mining argdamation, <br />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 permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />_ reclamation accomplished to date and_during the preceding yeaz, new disturbances that aze anticipated to occur <br />~~during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased For the year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map, If no new disturbances or reclamation have occurred during the previous veer and no new chanties to <br />the previous year's map are necessary. then no new map is required. provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Chazles Houchin <br />Permittee Name: Chazles W Houchin <br />Address: P.O. Box 162 <br />Green Mountain Falls, CO 80819 <br />Phone Number: (719) 684-9285 <br />Fax Number: (715) 684-2695 <br />If you have additional comments an o information that should be provided to the Division, please provide it <br />below or a~1+Rt;~i~L~ta'tlyis form alon~our written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />/-22-0 2 <br />Date <br />