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1~ <br />~~ ~ ~~ \ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Allen Drilling and Excavating Co., Inc. <br />M-2005-080 i// <br />Allen Pit <br />October 24, 2007 <br />~y RECEIVED / <br />OCT 0 3 2001 f <br />Division of ReGamation~ <br />Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Park <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 operator <br />- -- shall submit the annual-fee, a repov-and- map-showing-the-extL°nt-of-curretYc-disturbances-to-affected land,-- - <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual resort map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous vear and no new chances to <br />the previous vear's map are necessarv, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permit[ee Contact: Jack Allen <br />Permittee Name: Allen Drilling and Excavating Co., Inc. <br />Address: 651 Hwy 285 <br />P.O. Box 398 <br />Fairplay, CO 80440 <br />Phone Number: (719) 836-2672 <br />Fax Number: (719) 836-0715 <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 aze enclosed. <br />Sign of 'orporate f&cer, Owner, or Designee <br />~~- d `7 <br />Date <br />