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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE and POR RE UEST <br />/Kit Carson County <br />,./M-1991-069 <br />Heintges Pit <br />July 10, 2008 <br /> <br />,FCE°VE® <br />1-11 JUN 2 6 Nob <br />Division ota d S f ty n, <br />Mining <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Cheyenne <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 vour revised written annual report and annual report man 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 vear'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: Carol A. Fritz <br />Permittee Name: Kit Carson County <br />Address: P.O. Box 160 <br />Burlington, CO 80807 <br />Phone Number: (719) 346-8139 <br />Fax Number: (719) 346-7242 <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 /> <br />Signature of C orate Olff"icer, Owner, or Designee <br />?? . <br />Date <br />M:\PERMITIMASTERDOCUM ENTS\M-AF-04