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~~ <br />to -/o -a,~ <br />(> h'!l~ <br />"ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ~ <br />Bent County <br />PERMIT NO.: ~ <br />i/ M-1991-086 <br />OPERATION NAME: Earl-Hoffman-Reyher <br />ANNIVERSARY DATE: October 3, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Bent <br /> <br />OCT 0 2 2006 <br />Division of Reclamation, <br />Mining and Safety <br />--Aacoidingta-L.R:S-34=32:5-ti6-or~:R:S: 34=32=f~16; each year-on'the~anniversary-date of'the permii, 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 yeaz, 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 moo 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 durina the previous vear and no <br />new changes to the previous year's map are necessarv,then no new map 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 />PermitteeContact: Gary Pritchard <br />Permittee Name: Bent County <br />Address: 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 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 />Signature of Corpo\ a Officer, O erw15 or Designee <br />c~ 9 -a.~.. - ~ o~ co <br />Date ' <br />M:IPERM171MASTERD000MEMSUI-AF-04 <br />