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'~°° ~~. ~lVEC~ <br />ANNUAL FEE and REPORT REQUEST <br />DEC 0 8 2006 <br />- .-:,,,-; - ~ ,-,rims <br />J._.. y ~ <br />•..~n.l.~ ~~{~. J41G`lI <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Elbert County <br />M-1988-101 <br />Fondis Pit <br />December 15, 2006 <br />$$688.00 (Due on or before your anniversary date) <br />Elbert <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />]and, 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 yeaz, if any. <br />Please attach vour revised written annual report 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 uew disturbances or reclamation have occurred durinc the previous vear and no <br />new chances to the previous year's map 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: Marilyn Sproch <br />Permittee Name: <br />Address: <br />Elbert County <br />809 Ute Ave. <br />Simla, CO 80835 <br />Phone Number: (719) 541-2268 <br />Fax Number: (719) 541-2826 <br />~> <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 />Signature of Corporatebffi e~, Owner, or Designee <br />~~~ i~~~ <br />Date <br />M:IPERMI'11MA5"CERDOCUb7ENTSVv(-AF-04 <br />