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• J ? <br />-aP * WT <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />Rio Grande County <br />M-1978-065 <br />Seven Mile Plaza <br />October 22, 2008 <br />OCT 15 ?.033 ??J^/J -n F <br />Di'i3iGf C, ......Iaj lion, L <br />P,?-inin3 a rd Safety <br />$$323.00 (Due on or before your anniversary date) <br />Rio Grande <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=showirig'tlw-extent- of current disturbances to of etied -- <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 maD to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated may. If no new disturbances or reclamation have occurred during the previous year and no <br />new chances to the Drevious vear's map are necessarv. then no new map is required, Drovided 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: Patrick Sullivan <br />Permittee Name: Rio Grande County <br />Address: 168 N. Washington <br />Monte Vista, CO 81144 <br />Phone Number: (719) 852-4781 <br />Fax Number: (719) 852-0305 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below o ac it to this form along with your written report and map. Annual Report instructions are <br />encl ed. J a <br />t c-/ <br />S ature of Corporate Officer, Owner, or Designee <br />,0/ OGf- ego <br />Date <br />M: \PERMITIMASTERDOCUMENTS\M-AF-04