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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Imk ac- <br />ANNUAL FEE and REPORT QUEST <br />Grasser Construction, Inc. <br />./M-2001-052 <br />McCormick Pit <br />August 2, 2008 <br />E: D <br />--JUL 212008 <br />0 ion of r:e.;iWination, <br />Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Kit Carson <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 perfonned-during-tie-coming-year,-the-dates-for the-beginning of active operations, and the date active operations ceased for the <br /> year, if any. <br />Please attach your revised written annual report and annual report map 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 year and no new changes to <br />the previous year's map are necessary, then no new may 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 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: Jim McCormick <br />Permittee Name: Grasser Construction, Inc. <br />Address: 18071 CR 31 <br />Phone Number: <br />Fax Number: <br />P.O. Box 192 <br />Stratton, CO 80836 <br />(719) 348-5383 <br />(719) 348-5931 <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 />7 <br />- Z,- ?'? Livee0i:4,L Si ture of Corporate Officer, Owner, oK esignee <br />Date