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Wr <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Montezuma County OC . ?QQ$ v <br />PERMIT NO.: M-1978-107 t Jt. <br />JD/ <br />OPERATION NAME: Tozer Pit <br />ANNIVERSARY DATE: November 2, 2008 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Montezuma <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected _ <br />- land, reclamation accomplishe?lc to at?uring the preceding year; new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durine the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lloyd Everett <br />Permittee Name: Montezuma County <br />Address: 1680 North Highway 145 <br />Cortez, CO 81321 <br />Phone Number: (970) 565-8666 <br />Fax Number: (970) 565-8252 <br /> <br />If you have additional comments and/or information that sho be provided to the Division, please provide it <br />below or attach it to this form along with your writt report and map. Annual Report instructions are <br />enclose d. ` <br />/Zign-alure o Corporate Officer, Owner, or Designee a / ?O <br />Q0 ?$ <br />i0?7 LO <br />Date <br />M:TERNIITIMASTERDOCUMENTS\M-AF-04