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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />, <br />ANA FVE ageEPORT REQUEST <br />PProwers County <br />14-1977-387 <br />Bates Pit <br />December 1, 2008 <br />$$791.00 (Due on or before your anniversary date) <br />Prowers <br />J <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 aril map showing-Elie extent of current disturbances to affe?ed -- - <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 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 during the previous year and no <br />new changes 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 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: Tony Garcia 6'j {ce-? <br />Permittee Name: Prowers County <br />Address: 109 E. Sherman St. <br />Lamar, CO 81052 <br />Phone Number: (719) 537-6631 r7l??3w Cf'2L <br />Fax Number: (719) 537-6357 71 ? <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 />Signature of Corporate Officer, er, or Designee <br />//-, ?l G <br />Date <br />M:\PERMIT WIASTERDOCUMENTS\M-AF-04