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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />01I <br />A L <br />,r 7- le? ANNUAL FEE and REPORT REQUEST <br />ArJefferson County <br />VM-1977-245 <br />RECEIVED <br />A-bEC 19 2008 <br />Division of Reclamation, <br />Mining and Safety <br />Pine Junction Pit <br />January 31, 2009 <br />$$791.00 (Due on or before your anniversary date) <br />Jefferson <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 rep-- or and amp swing 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 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 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: Louis Anderson <br />Permittee Name: Jefferson County <br />Address: 21401 Golden Gate Canyon Road <br />Golden, CO 80403-8108 <br />Phone Number: <br />Fax Number: <br />(303) 271-5205 <br />(303) 271-5222 <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, Owner, or Designee <br /> <br />Date <br />M: PERMIT\MASTERDOCUMENTS\M-AF-04