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ANAL FEE and REPORT REQUEST <br /> f <br />PERMITTEE NAME: Fremont County RECEIVE <br />PERMIT NO.: ?M-1986-010 DEC 2 6 2008 <br />OPERATION NAME: Cottonwood Pit Division of Reclamation, <br /> <br />ANNIVERSARY DATE: <br />January 20, 2009 ,{,Mining and Safety <br />fir/ <br />ANNUAL FEE DUE: $$791.00 (Due on or before yo ur anniversary date) <br />COUNTY: Fremont <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 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 your revised written annual report and annual report man 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: Curtis Stone <br />Permittee Name: Fremont County <br />Address: Fremont County Commissioners <br />615 Macon Ave., Room # 105 <br />Canon CIty, CO 81212 <br />Phone Number: (719) 276-7320 <br />Fax Number: (719) 275-7626 <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 />Ap -elr ? <br />Signature of Corporate Offi , Owner, or Designee <br />Date <br />M:IPERMTIIMASTERDOC UMENTS\M-AF-04