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~.,~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Washington County <br />M-1998-065 <br />Hayes Pit <br />September 18, 2007 <br />~,~tG~ <br />oSM~~~o9 aoC s e~N <br />$$323.00 (Due on or before your anniversary date) <br />Washington <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 />- - - opcratorhaH submit-the-annual-fce,- areport-and-map-showing-thc•eztcnt-ofcurrent-dishubances-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 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 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: Jesse J. Stackhouse <br />Permittee Name: Washington County <br />Address: 150 Ash <br />w e ~a-~.-e r~l ~ t.~ ~ d <br />~~-e~w, w a ~G - ~ oc3 6 <br />~`~ l4 tig 27- ~-Op7 <br />Almon, CO 80720 <br />Phone Number: (970) 345-2701 <br />Fax Number: (970) 345-2702 <br />N o -4.cr~.-v,~ t7 ~rnsZ <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 />enclo ed. <br />gnature o or orate Officer, Owner, or Designee <br />~- ~ 7 - ~ ~~ <br />Date <br />M:~PERMITMASTERDOCUMENTS~M-AF-04 <br />