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czu/ <br />Y ANNi1AI. FRF, and REPORT RF.t1i1F.ST <br />PERMITTEE NAME: v growers County / 3 <br />PERMIT NO.: t/M-1987-009 . <br />OPERATION NAME: Jones Pit East <br />ANNNERSARY DATE: February 26, 2006 <br />ANNUAL FEE DUE: $688.00 (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 />operator shall submit the annual fee, a report and map showing [he 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 ymir revised written annnal rennrt and annnal rennrt m ~n fn this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may stffce 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: Mark Dorenkamp <br />Permittee Name: Prowers County <br />Address: 301 S. Main, Ste. 215 <br />Lamar, CO 81052 <br />Phone Number: (719) 336-5536 <br />Fax Number: (719) 336-2255 <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 />/-_~~_o~ <br />Date <br />M:V'ERM 1'I4M ASTERDOCUM ENTSN4-AF-04 <br />