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l9~ ~~/~l <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ~ Grasser Construction, Inc. <br />PERMIT NO.: ,/M-2001-052 <br />OPERATION NAME: McCormick Pit <br />ANNNERSARY DATE: August 2, 2007 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Kit Carson <br />REG~~ /~~ <br />~'JUL 1 ~ 2007 <br />DV/ision of h~cla7ation, <br />~ Mining and Safety <br />According [o C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />recl'arnafion accomph`shed-fo da~and during the preceding year,-riew disfurliances thaCare-anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />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. The Annual Report <br />& Fee requirement is not met until we have received the followiug components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous vear and no new chances to <br />the previous year's map are necessary. then no new moo is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Jim McCormick <br />Permittee Name: Grasser Construction, Inc. <br />Address: 18071 CR 31 <br />Stratton, CO 80836 <br />Phone Number: (719) 348-5383 <br />Fax Number: (719) 348-5931 <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 enclosed. <br />i~_14~C Mb.... U~1rr_.~-~ <br />~gnature of Corporate Officer, Owner, or Designee <br /> <br />Date <br />