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'?' '?-7 "', kp--k' <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lowell Klinglesmith & Lenny Klinglesmith <br />M-1978-221 <br />K-Bar-T Pit <br />August 23, 2008 <br />A 2008 <br />New- <br />Glinin9 Znd <br />$323.00 (Due on or before your anniversary date) <br />Rio Blanco <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 shall <br />submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation <br />accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the upcoming <br />year,- reclamation-that-wi-11 be-performed-during-the-coming-year,-the-dates for-the-beginning-ofaetive-operations; and-the- _ <br />date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report may to this form The Annual Report & Fee <br />requirement is not met until we have received the following components: fee, report, and associated may. If no <br />new disturbances or reclamation have occurred during the previous year and no new chances to the previous <br />year's map are necessarv, then no new map is required, provided that the Operator shall state this in the Annual <br />Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary changes: <br />Permittee Contact: Lowill Kliuv&smii(h I n n / , n <br />l <br />Permittee Name: Lowell Klinglesmith & Le y Klinglesmith <br />l <br />Address. 7576 CR 13 <br />P.O. Box 1164 <br />Meeker, CO 81641 <br />Phone Number: (9,70) 878-4858 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it be ow or <br />attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Na ?? s? ^?eJ?"r?^GC f t?`?n a.?: sV+ u ?a'?? vTwr 1 i tai i ?0.c?T 1Vc- <br />gn o orporate Officer, Owner, or Designee <br />D e