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NIAY-02-2008 04:O1PM FROM-DIV RECLAMATION f~IINING ~ SAFETY +3038328106 <br />~'> <br />PERMLTTEE NAME: <br />PERMIT NO.; <br />OPERATION NAME: <br />ANMVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />fjSan Miguel Couaty <br />~I-1989-030 <br />Zadra Pit <br />May is, zoos <br />$S791.00 (Dne on or before your anniversary date) <br />San Miguel <br />~~~ ;~~~ <br />~~?~o <br />,,~'aJsa era <br />_ According to C._R.S. 34-32.5-116 yr 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 cur~enf 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 maD to this form. The Annual <br />Report &.Fee requirement is cot met until we have received the following components: fee, report and <br />associated map. If uo new disturbances or reclamation. have occurred during the previous veer and no <br />new changes to the previous vest's map are accessstry. then uo new man is required. provided that the <br />Q erator shall state this in the Annual Re ort. Please ,role that an adequately Jabeled map that clearly <br />delineates and includes the above eleme~rts tnay since for u written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mike Horner <br />Permittee Name: San Miguel County <br />Address: P_O. Box 426 <br />Norwood, CO 81423 <br />Phone Number: (970} 32?-4835 <br />Fax Number: (970} 327-4090 <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 fotzn along with your written report and map. Annual Report instructYOns are <br />enclosed. <br />-1 ~~W~-lam. <br />Signature of Corporate Officer, Owner, or Designee <br />~30 ~ D ~ - - <br />Date <br />~t 1 <br />ANN[Jr~,L' FFE atsd PO T"RE~UEST <br />T-678 P.002/002 F-94B <br />M:~YERM l'[\MASTERDOCUM6N7S~M-nF.Oa <br />