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ANNUeiI. FEE and REP RT REQUEST <br />~`b~,~=' <br />PERMITTEE NAME: /Yuma County '~'fP <br />'~20p <br />PERMIT NO.: '~'~ - ~ ~($fr' -~ 5 ~n Divi loo o~ ~ ~ <br />Ainincc~,j ~c. <br />OPERATION NAME: G`~kt7erg PTf ~= .. -" <br />ANNIVERSARY DATE: (o~3d(U1~ 7 <br />ANNUAL FEE DUE: ~ 79/. rO (Due on or before your anniversary date) <br />COUNTY: Yuma <br />According to C.R.S. 34-32.S-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the anttual 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 year, if any. <br />Please attach vour revised written annual reaort and annual resort map to this form. The Anneal <br />Report & Fee requirement is not met until we have received the following components: fee, reaort, and <br />associated map. If no new disturbances or reclamation have occurred darine the previous veer and no <br />new chances to the previous vest's mac are necessary, then no new map is required, provided that the <br />Ouerator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may su,Jfice for a written report. <br />Division records indicate the following permittee contactinfotmation. Please verify and make any necessary <br />changes: <br />Permittee Contact: Paul Like <br />Pennittee Name: Yuma County <br />Address: 1310 S. Blake St. <br />Wray, CO 80758 <br />Phone Number: (970) 332-5718 <br />Fax Number: (970) 332-3429 <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 />p <br />Signature of Corporate fficer, Owner, or Designee <br />'1 1 t t <br /> <br />Date <br />