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<br />.~`~ <br />i/ ANNiIAI. FF.F, and RF.PnRT RFOUF.ST <br />t/APR 14 2006 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATF,: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ Phillips County <br />M-1994-007 <br />Johnson Pit <br />May 23, 2006 <br />RECEt~E <br />~Oivision of Miner : ~_ . <br />$688.00 (Due on or before your anniversary date) <br />Phillips <br />iVl<~syz. <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 />-Y--land; reclamation accomplished Yo date and~uring 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 Ynnr revised written anmtai rennrt and annnal re nn rt main to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br /> <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Randy Schafer <br />Permittee Name: Phillips County <br />Address: 221 S.Interocean <br />Holyoke, CO 80734 <br />Phone Number: (970) 854-3778 <br />Fax Number: (970) 854-3811 <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 />~ ~~ ~ <br />Signature f Corporal Officer, Owner, or Designee <br />/a'~~t.. ~ 2/,t~~ <br />Dat ' <br />M:IPERMITVNASTEAlK)CUMENTS4M-AF-04 <br />