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_ ~r <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />RECEIi/~~ <br />FEB ~ ~ 2008 ~„~ <br />Division of Keclamat~on, ,/ <br />iUfining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Kiowa <br />-- - ~ - ~4ceordi*_:g to-C:R_:S. 34=32._4 t 16 or C.R.:S_3_4,32-1_L6, each. y_ear,~ on the. anniversary date of the_~ermit, 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 during 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: Allen Watts <br />Permittee Name: Kiowa County <br />Address: P.O. Box 100 <br />Phone Number: <br />Fax Number: <br />Eads, CO 81036 <br />(719) 438-5810 <br />(719) 438-5327 <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 />Si ture of Corporate Officer, Owner, or Designee <br />Date <br />ANNUAL FEE nd REPORT RE VEST <br />Kiowa County / <br />M-1985-173 / <br />Rother Gravel Pit <br />February 3, 2008 <br />M:IPERMITU~SASTERDOCUMENTSU~i-AF-04 <br />