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bfv~i~ <br />1/ ANN[TAT. FF,F. and RF,PTTRT RF.TIiIF.ST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~K//it Carsou County <br />t~I-1982-079 <br />Brenner Pit ~ <br />June 24, 2006 <br />RECEIVED <br />(1G 10 2006 <br />" uivision of ReGamation <br />M~om9 and Safety ' <br />$281.00 (Due on or before your anniversary date) <br />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 <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 yeaz, if any. <br />Please attach ymir revised written annnal report and annnal rennrt maTtn this Snrm- Please note that an <br />adequately labeled map that clearly delineates ar:d 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: 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 <br />enclosed <br />ua[e <br />M:IPERMIT4MASTERDOCUMENTSM-AF-04 <br />