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<br />PERMITTEE NAME: <br />PERMTi' NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~ ~~)ZJ~ <br />ANNUAL FEE an PORT REQUEST <br />ICiowa Couuty <br />/M-1983-109 <br />Aldrich Gravel Pit <br />August 25, 2007 <br />$323.00 (Due on or before your anniversary date) <br />Kiowa <br />RECEIVED <br />~ AUG 0 ~ 2007 <br />Division of Reclamation, <br />~ Mining and Safety <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and-rirap showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Aunual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous veer and no <br />new chances to the previous year's map are necessary. then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Rick Spady p~~~$ ~~~~'1 ~j~p~~/1 ~~ <br />Permittee Name: Kiowa County ~Y/,D f-l~l~l~lll ~-/~ /~S /l2-/%I/il/s <br />Address: P.O. Box 100 /riliQj/F_L f}~L,p f~~<fL-/~f`- <br />Eads, CO 81036 <br />Phone Number: (719) 438-5810 <br />Fax Number: (719) 438-5327 <br />If you have additional comments and/or informafion 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 aze <br />enclosed. <br />gnature of Co porate ~cer, Owner, or Designee <br />.3y- o~ <br />Date <br />M:~PERMITMASTERD000MENTSUI-AF-04 <br />