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<br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Las Animas County RECEIVED <br />PERMIT NO.: M-1979-163 ~~T 2 8 20~ <br />OPERATION NAME: Shannon Pit <br />Division of Minerals and Geology <br />ANNIVERSARY DATE: September 27, 2002 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Las Animas <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-] 16, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and ma~showing_the extent of.current_dis[urbances_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 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 suffice 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: Phil Dorenkamp <br />Permittee Name: Las Animas County <br />Address: 2000 N. Linden Ave. <br />Trinidad, CO 81082 <br />phone_Numbec: _(7a 9).846,44R6 _-- <br />Fax Number. (719) 846-7160 <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 />Dale <br />M:~PF.RMITUI ASTER DOCU MENTSNI-AF-04 <br />