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~~ <br />~" <br />J <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Provers County <br /> / <br />/ <br />PERMIT NO.: M-1984-140 ~ <br />OPERATION NAME: Walker Pit North <br />ANNIVERSARY DATE: August 31, 2007 <br /> <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Provers <br />pCf+GI\/Cn r <br />SEP 0 4 2007 `f <br />DivMiningtand Safety n~ <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 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 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 durin¢ the previous year and no <br />new chanties to the urevious 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 inchedes the 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 />Permittee Contact: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Mark Dorenkamp <br />Provers County <br />109 E. Sherman St. <br />Lamar, CO 81052 <br />(719)336-5536 <br />(719)336-9633 <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 />~~~ _~~~~ <br />~ibrmature of orporate Officer, O er, or Designee <br />dam! ~ ~ ~ <br />Date <br />M:~P13RM1TMASTERD000hiGNTSUI-AF-04 <br />