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i. <br />°`~i <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUA~FEE a~REPORT REQUEST <br />~ Otero County <br />~I=2004-027 <br />Mendenhall Pit <br />August 20, 2007 <br />R~(r!c~E/~F <br />~~'iSionV v Ov Z00j O <br />Mining a~d Sa ely on. <br />$791.00 (Due on or before your anniversary date) <br />Otero <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 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinti the previous year and no <br />new chanties to the previous year's map are necessary, then no new man is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map tJaat clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Kenneth S. Parker <br />Permittee Name: <br />Address: <br />Otero County <br />13 W. 3rd St. <br />P.G. Box 511 <br />La Junta, CO 81050 <br />Phone Number: (719) 383-3035 <br />Fax Number: (719) 383-3935 <br />~rt^r1' ~C~l1In <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below o~attach it to this form along with your written report and map. Annual Report instructions are <br />Signature of <br />Date <br />