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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~ ~- RP-~ <br />ANNUAL FEE and REPORT REQUEST <br />Prowers County / <br />M-1987-009 ,./ <br />Jones Pit East <br />February 26, 2008 <br />RECEIVED <br />JAN 3 ~ 2008 <br />Division or rteclamati0n, ~~~~ <br />Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Prowers <br />__ _ _ _According_to C.R.S. 34-3_2.5-116 or C.R.S_34-32-116, each ear, on the anniversarydate 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 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 durin 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: Mark Dorenkamp <br />Permittee Name: Prowers County <br />Address: 301 S. Main, Ste. 215 <br />Lamar, CO 81052 <br />Phone Number: (719) 336-5536 <br />Fax Number: (7, - <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, er, or Designee <br />~~ /~'~'~ <br />Date <br />M:~PERMITIMASTERDOCUMENTS~M-AF-04 <br />