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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />City of Rifle <br />M-2007-030 <br />City of Rifle Material Resource Area <br />June 13, 2008 <br /> <br />JUN 0 9 200€ <br />Division of a d Sa etY n <br />Mining <br />$$323.00 (Due on or before your anniversary date) <br />Garfield <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 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 may 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br /> John Hier, City Manager <br />Permittee Contact: Bill Sappington <br />i <br />Permittee Name: City of Rifle City of Rifle <br />Address: Public Works Director <br /> 202 Railroad Avenue <br /> Rifle, CO 81650 <br /> (970) 625-6266 <br />Phone Number: (970) 625-6223 <br />Fax Number: (970) 625-6268 <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 />ature of Corporate Officer, Owner, or Designee <br />'C; --ng <br />Date <br />M APERNTIMASTERDOCUMENTSW-AF-04