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.~~ ~~ <br />/ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: V owa County <br />PERMIT NO.: M-1991-078 <br />OPERATION NAME: Peters Pit <br />ANNNERSARY DATE: February 4, 2007 <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: Crowley <br />,.. <br />©l~ 15'a'~ <br />R~C~I~I~~ <br />~JA11 i 5 2G01 <br />Dwm~~..~~ ~~ ~•.~~~~+naiion, <br />Mining and Safely <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 di"sturliance`s 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 resort and annual resort 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 durinti the previous vear and no <br />new chanties 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 elemenls may su ece for a written report.- -- ""` - - - -" - <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Rick Spady <br />Permittee Name: Kiowa County <br />Address: P.O. Box 100 <br />Phone Number: <br />Fax Number: <br />Eads, CO 81036 <br />(719) 4385810 <br />(719)438-5327 <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 />Signature of Corporate Officer, Owner, or Designee <br />Date <br /> <br />M:~PEAMITMASTERDOCUMENTSIM-AF-04 <br />