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<br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUf's: <br />COUNTY: <br />fl ~ ` l\ P7 <br />ANNUAL ~'EE and REPORT REQUEST <br />Rio Grande County <br />~M-1987-019 <br />South Fork Pit <br />March 25, 2008 <br />$$323.00 (Due on or before your anniversary date) <br />Rio Grande <br /> <br />~~~~an of Kecialt~ation, <br />ding and Safety <br />~~qR j 0 X00$ <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 aa;omplished 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 requiirement is not met until we have received the following components: fee, report, and <br />associated man. If no new disturbances or reclamation have occurred durin the previous year and no <br />new chances to the previous year's map are necessary, then no new man 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 inclua!es 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: Patrick Sullivan <br />Permittee Name: Rio Grande County <br />Address: 168 N. Washington <br />:Monte Vista, CO 81144 <br />Phone Number: <br />Fax Number: <br />1;719) 852-4781 <br />1;719) 852-0305 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or to this form along with your written report and map. Annual Report instructions are <br />encl d. <br /><~' . <br />Signature of Corporate Officer, Owner, or Designee <br />~/J.S~'I~9,e OB <br />Date <br />M:V'ERMI7IMASTERDOCUMEIVTS~M-AF-04 <br />