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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ f ~'~ i <br />ANIVU~FEE and REPORT REQUEST <br />Chaffee County <br />~M-1978-192 <br />Pit No 6 <br />June 30, 2007 <br /> <br />RECEIVED <br />''JUN 0 4 2007 <br />Djvision of Reclamation, <br />Mining and Safety <br />$$281.00 (Due on or before your anniversary date) <br />Chaffee <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 />operato* chap cuhmit_the_annual~'ee,_aseport 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 your revised written annual resort 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 map. If no new disturbances or reclamation have occurred durinti the previous year and no <br />new chanties to the previous year's man 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 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: Joe Nelson <br />Permittee Name: Chaffee County <br />Address: POB 699 <br />Salida, CO 81201 <br />Phone Number: (719) 539-6961 <br />Fax Number: (719) 539-7442 <br />,~0 <br />,\r.0~~ <br />V <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 azure of orporate Officer, Owner, or Designee <br />~"~ - d~ <br />Date <br />M:~PERMI7IMASTERDOCUMEMSM-AF-09 <br />