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ANNUAL FEE and REPORT REQUEST <br />PE1tMITTEE NAME: Kit Carson County <br />PERMIT NO.: M-1982-098 i <br />OPERATION NAME: Beattie Pit #1 <br />ANNIVERSARY DATE: June 24, 2006 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) ~ <br />i <br />COLIN'I'Y: Kit Carson <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 i <br />occur during the upcoming yeaz, 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 yeaz, if any. '~ <br />ch your revised written anneal report and annual reuort maa to tbis form. Please note that an <br />labeled map that clearly 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 />Pernvttee Contact: Lyn Brownfield <br />Permittee Name: Kit Carson County <br />Address: P.O. Box 160 <br />Burlington, CO 80807 <br />Phone Number: (719) 346-8139 <br />Fax Number: (719} 346-7242 <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 />Signature of Corporate Officer or Owner <br />Date <br />