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f) <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Kr'?Va? 4 aor <br />ANNUAL FEE and REPORT REOUEST <br />Washington County <br />M-2000-084 '-Z <br />Chris Aaegeson Pit #2 <br />RECEIVED <br />SEP 15 2008 <br />Division of reclamation, <br />Mining and Safety <br />August 30, 2008 <br />$323.00 (Due on or before your anniversary date) <br />Washington <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, reclamation <br />accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the <br />upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active <br />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 Report & <br />Fee requirement is not met until we have received the following components: fee, report, and associated map. <br />If no new disturbances or reclamation have occurred during the previous year and no new changes to the <br />previous year's map are necessary, then no new map is required, provided that the Operator shall state this in <br />the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above <br />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: Jesse Stackhouse U ?l ? s M ' ;V e <br />Permittee Name: Washington County /0( O <br />Address: 150 Ash Avenue O? <br />Akron, CO 80720 <br />Phone Number: (970) 246-3347 ' <br />Fax Number: (970) 345-2702 <br />If you have additional comments and/or information that should be provided to the Division, please provide it below <br />or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />?:? 0 4 / LL42--?-? <br />iOwner, or Designee <br />?S, V- ?-° ° <br />Date <br />M:\PERMIT\MASTERDOCUMENTS\NI-AF-04 <br />- -- 9