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<br />A~ ~- ~ ~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Elbert County / -,~ IC '~ ~° ~ y ~ ~.,_. <br />PERMIT NO.: M-1988-101 ~/ ®~C ~ ~ / <br />OPERATION NAME: Fondis Pit ~ 007 t/ <br />~ivisi0n of Raciamatian, <br />ANNIVERSARY DATE: December 15, 2007 Mining and 1'afety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Elbert <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 vour revised written annual report and annual report man 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 disturbafices or reclamation have occurred Burin the previous year and no <br />new changes 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: Marilyn Sproch <br />Permittee Name <br />Address <br />Elbert County <br />809 Ute Ave. <br />Simla, CO 80835 <br />Phone Number: (719) 541-2268 <br />Fax Number: (719) 541-2826 <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 />L~ ,~.. ~- <br />Signature of Corp ate Officer, r Designee <br />Date <br /> <br />M: ~PERMIT~MASTERDOCUMENTSUvt-AF-04 <br />