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y <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL' FEE Ad REPORT RE VEST <br />/ " p ero County (Engineering) <br />1981-279 <br />Hancock Gravel Pit <br />February 1, 2009 <br />o /< <br />l\/® <br />7AN 16 2009 <br />Division of Reclamation, <br />Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Otero <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, reportand map showing the extant`ofcurrent-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 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: Darryl L. Schulz <br />Permittee Name: Otero County (Engineering) <br />Address: P.O. Box 511 <br />La Junta, CO 81050 <br />Phone Number: (719) 383-3035 <br />Fax Number: (719) 383-3935 <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 />Sigriature,ofiCorporate Officer, Owner <br />j - 7-09 <br />Date <br />M:V'ERMI'RMASTERDOCUMENTSIA4-AF-04