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ANNUAL FEE and REPORT RE VEST <br />MECEIVE® <br />PERMITTEE NAME: Washington County AECPrv/',FD <br />PERMIT NO.: M-2004-021 ?JUL I ? 2008 JUL 0 2 2008 <br />OPERATION NAME: Starlin Pit ivision of rcacc .ndiiork, division of nd Saf ation, <br />and Satety Mmmg and Safety <br />Mining <br />ANNIVERSARY DATE: July 13, 2008 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Washington <br />--- Accor-ding--to-C.R S-34 32-.5446-or-C:R-S-34-32--11-6,-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 necessarv. 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: Ti (v??i?r t VW <br />Permittee Name: Washington County <br />Address: 150 Ash Avenue <br />Akron, CO 80720 <br />Phone Number: (970) 345-2337 <br />Fax Number: (970) 345-6593 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or ttach it to this form along with your written report and map. Annual Report instructions are <br />en7/d;4IV atu <br />re of Corporate Offer, Owner, or Designee <br />? 1 J '? U <br />Date <br />M: \PERMITIMASTERDOCUMENTSIM-AF-04