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IIIIIIIIIIIIIIII <br /> ANNUAL FEE and REPORT REOUEST RECEIVED <br /> PERMITTE:E NAME: Kiowa County NOV 0 6 2000 <br /> PERMIT NO.: M-1991-074 Division of Minerals and Geology <br /> OPERATION NAME: Barnett Pit <br /> ANNIVERSARY DATE: November 12,2000 <br /> ANNUAL FEE DUE: $688.00(Due on or before your anniversary date) <br /> COUNTY: Kiowa <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 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 o:.`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: Rodney Hopkins <br /> Permittee Name: Kiowa County <br /> Address: P.O. Box 100 <br /> Eads, CO 81036 <br /> Phone Number: (719) 438-5810 <br /> Fax Number: (719)438-5327 <br /> If you have additional comments and/or information that should be provided to the Division, please provide it <br /> below or auach it to this form along with your written report and map. Annual Report instructions are <br /> enclosed. <br /> 1 <br /> gnature of Corpo [t Offi r or Owner <br /> / D 1 <br /> Date <br /> NIVERMmMASTI.RDOCUMEN MM AF-04 <br />