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°l ~ ~ I <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Otero County (Engineering) <br />M-1981-279 <br />Hancock Gravel Pit <br />February 1, 2008 <br /> <br /> <br />~,~ ~ ~ ~ F~ <br />e,t :_~; , <br />$791.00 (Due on or before your anniversary date) <br />Otero <br />According to C:R.S. 34-32.5-11E 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 <br />affected land, reclamation accomplished to date and during the preceding year, new disturbances that are <br />anticipated to occur during the upcoming year, reclamation that will be performed during the coming year, <br />the dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your 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, resort. <br />and associated map. If no new disturbance or reclamation have occurred during the previous year <br />and no new changes to the previous year's map are necessary, then no new map is required, provided <br />that the Operator shall state this in the Annual Report. Please note that an adequately labeled map <br />that clearly delineates, and includes the above elements may suffice for a written report. <br />Division records indicate the following perm tee contact information <br />necessary changes: <br />~ermittee Contact: <br />Permittee Name: <br />Address <br />Kenneth S. Parker <br />Otero County (Engineering) <br />P.O. Box 511 <br />La Junta, CO 81050 <br />Phone Number: <br />Fax Number <br />(719)383-3035 <br />(719)383-3935 <br />Please verify and make any <br />Darryl L. Schulz <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />it below or attach it to this form along witJl your, written report and map. Annual Report instructions are <br />e closed. '~ ^' " <br />Signature of,Corporate office~,'f /OwnerJlO, r De ' ee <br />r % ,f' <br />~--/ ~- ate g ~..- <br />Date <br />M:~PERMIT/MASTERDOC UMENTS~vI-AF-04 <br />