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• r , '. III IIIIIIIII IIII III <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEiE NAME: Bent County RECE1vEC <br />PERMIT NO.: M-1991-086 SEp 2 g 2001 <br />OPERATIC>N NAME: Earl-Hoffman-Reyher Gnalogv <br />ANNIVER:iARY DATE: October 3, 2001 pivision of Minerals and <br />ANNUAL 1'EE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Bent <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 Burin;; 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 vour revised written annual report and annual report map to this form. Please note tltot art <br />adequate/y labeled reap thnt c/enr[v de/ineates and includes the nbove elements may since fora written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Gary Pritchard <br />Permittee Name: <br />Address: <br />Bent County <br />P.O. Box 350 <br />Las Animas, CO 81054-0350 <br />Phone Number: (719) 456-2223 <br />Fax Number: (719) 456-0375 <br />If you have ;tdditional 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 />~~~~_~~ <br />Signa a of Corporate Officer or Owner <br />S~oTEw.6E~ 35~ X200/ <br />Dare <br />M WERM1tITNiASTE RDOCUMENTSUI-AF-0.1 <br />