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.: <br />t•,. :- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~;~~r <br />ANNUAL FEE and REPORT REQUEST <br />iMontrose County <br />~M-1984-152 <br />Grizzly Ridge Pit <br />September 27, 2007 <br />$$323.00 (Due on or before your anniversary date) <br />Montrose <br />d-G <br /> <br />RE~~1~E p <br />~I U~ 2 9 2007 <br />~sion or Reclamation, <br />Mining and Safefy <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 />- op`ei•ator shall submit-the anriuaTfee, a report-an'd`map showmg~e~ent of current disturbances to a~ of cted <br />land, rec]amation 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 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 durinc the previous year 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: Brian Wilson <br />Permittee Name: <br />Address: <br />Montrose County <br />161 S. Townsend <br />Montrose, CO 81401 <br />Phone Number: (970) 252-7000 <br />Fax Number: (970) 252-7010 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it his form along with your written report and map. Annual Report instructions are <br />sed. <br />t ure of Corporate Officer, Owner, or Designee <br />~(C~ I ~~ <br />Date <br />M:~PERMI7IMASTERDOCUMENTSNI-AF-04 <br />