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/~ ~ Y R P i <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Las Animas County <br />/~M-1979-163 <br />Shannon Pit <br />September 27, 2005 <br />~~ <br />~Ep p 8 2005 <br />Division of ryiiuaml; L Gcologtl <br />$281.00 (Due on or before your anniversary date) <br />Las Animas <br /> <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-ofcurrent disturbance~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 rennrt and anmral re nrn t man 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: Phil Dorenkamp <br />Permittee Name: Las Animas County <br />Address: 2000 N. Linden Ave. <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-2931 <br />Fax Number: (719) 846-0434 <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 />of <br />or Designee <br />~.~ - n S~U <br />Dale <br />M:~PERM IM/ASTERDOCUMENTSNI-AF-04 <br />