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~~ ~ ~/ / <br />ANNUAL FEE and REPORT REQUEST <br />PERMTI'TEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Las Animas County <br />~M-1999-060 <br />Yocam Pit <br />June 15, 2007 <br />$$281.00 (Due on or before your anniversary date) <br />Las Animas <br />~n <br />R~CEIV~ ~-~ <br />~ !JUN 14 2007 <br />p' slop of Rea Sa:. . <br />Mining <br />- According to C:R:S.-34-32.5-116-or G.R.S-34-32-1-16;-each year,-or.-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 vour revised written annual report and annual report man 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 durin¢ the previous vear and no <br />new changes 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 that clearly <br />delineates and includes the 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: Phil Dorenkamp <br />Pennittee 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 />Officer, C}dmer, or Designee <br />Date <br />M:~PERMITVNASTERDOCUMENTSNI-AF-04 <br />