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rv.Gx- ~'~- ~ <br />~n <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Adams County / ~G~iG' !I G~ <br />PERMIT NO.: M-1977-283 / oa V <br />OPERATION NAME: Debetz Pit ,IAN 17 2Q <br />Division or keciamation, <br />ANNIVERSARY DATE: December 21, 2007 Mining and Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Adams <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 ann"uaI tee, a ieport an~map showing the extent of currenf disturbances fo 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 disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is reauired, 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 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 />Craig Tessmer <br />Adams County <br />Address: <br />450 S. 4th Avenue <br />Brighton, CO 80601 <br />Phone Number: (303) 853-7003 <br />Fax Number: (303) 853-7015 <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 />~~~a=~iCs`a~1` # S <br />~aal~lcal~er <br />M:~PERMIIIMASTERDOCUMENTSV~f-AF-04 <br />