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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />AL FEIJ and PORT REQUEST <br />hillips County <br />M-1990-116 <br />Kennedy Pit <br />October 26, 2008 <br />d/,-- <br />(!fCS <br /> <br />Division o <br />9:,111ing and sstaV1 <br />$323.00 (Due on or before your anniversary date) <br />Phillips <br /> <br />----_ ---.According-to-C.R.S._34-32.5-1.1-6_or_C.R.S._3-4=32--1-1.6,._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 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 may 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 chances to the previous vear'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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Randy Schafer <br />Permittee Name: Phillips County <br />Address: 221 S. Interocean Ave. <br />Holyoke, CO-80734 <br />Phone Number: <br />Fax Number: <br />(970) 854-3778 <br />(970) 854-3811 <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 <br />enclosed. <br />627? 21/22?? <br />Signature o orporate Officer, Owner, or Designee <br />/0 <br />Date <br />M:\PERMrrMASTERDOCUMENTS\M-AF-04