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G~ <br />A-~~~~i <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: jCity of Lamar RECEIVE D <br />PERMIT NO.: M-1987-078 JUN 14 2007 <br /> <br />OPERATION NAME: Lamar Park Grav Pit ~ ion of Reclamation, <br /> Mining and Safety <br />ANNIVERSARY DATE: June 24, 2007 <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: Prowers <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 />operatorshall submit the annual fee; a`report anti- map showm-" g i i1 a ex ent o Curren ots r antes o a Yecte <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 renort 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 mau. If no new disturbances or reclamation have occurred durinc the previous veer and no <br />new chances to the previous year's map are necessary, then no new map is required, arovided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delinedtes and includes the above elemends may suffice for a written report. <br />Division records indicate the following petmittee contact information. Please verify and make any necessary <br />changes: <br />PetYnittee Contact: Pahick Mason <br />Permittee Name: City of Lamar <br />Address: 102 E. Parmenter St. <br />Lamar, CO 81052 <br />Phone Number: <br />Fax Number: <br />(719)336-4495 <br />(719) 336-4404 <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 />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:~PERMI7IMASTERDOCUMENTSUI-AF-04 <br />