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/D, <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNiJAL FEE DUE: <br />COUNTY: <br />~_ ~ ~PP~ <br />A UA~F~E and REPORT REQUEST <br />'Crowley County <br />s3~ i ~o~ <br />f~~~ <br />`~M-1982-126 `MAR 1 12008 <br />Crowley Cnty Grav 2 ision o. ~ecia~nation, <br />Apri128, 2008 Mining and Safiety <br />$$791.00 (Due on or before your anniversary date) <br />Crowley <br />According to C.R:S. 34=32.5=I16-or C:R.S: 34=32-1i6, each year,- on the anniversary date of the pei-init, 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 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: Mike Apker <br />Permittee Name: Crowley County <br />Address: 603 Main St. Ste. 2 <br />Ordway, CO 81063 <br />Phone Number: (719) 267-4444 / ~ 9 ~ ~O 7 .J ,S`~,j ~ 02, <br />Fax Number: (719) 267-3114 <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 facer, Owner, or Designee ~ ~ ~ <br />/ ~©d <br />Date /~~'"J <br />3l~ to ~ <br /> <br />M:~PERMIIIMASTERDOCUMENTS~iv1-AF-04 <br />