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~~ ~ RQ~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT RE UEST <br />Mike Bennett / <br />M-2007-021 ~/ <br />Bennett Pit <br />June 18, 2008 <br />$$323.00 (Due on or before your anniversary date) <br />Yuma <br />~~~~o~~~ <br />MAY 1 6 2008 ~ <br />Division os keciamation, 1 y <br />Mining and Safety ~ <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />-reclamation-accomplished--to-date_and during the .preceding year, new disturbances that_are anticipated to occur _ ___~- _ __ <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous vear and no new changes to <br />the previous year's m__ap are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Mike Bennett <br />Permittee Name: <br />Address <br />Mike Bennett <br />39533 Co. Rd. 18 <br />Holyoke, CO 80734 <br />Phone Number: (970) 854-2381 <br />Fax Number: <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 enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />~' ~s -act <br />Date <br />