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K;? 5k ? i <br /> ANNUAL FEE and REPORT REOUEST <br /> t'?F <br />PERMITTEE NAME: Rio Grande County <br />PERMIT NO.: M-1987-019 <br />OPERATION NAME: South Fork Pit <br />ANNIVERSARY DATE: March 25, 2009 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Rio Grande <br />Division o: rs'ecienation, <br />Mining and safety !--P <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 sTiall- submit the annual fee a report and map showing the extent- of eurrerit-isturbances 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 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 chanLyes to the nrevious vear's man are necessarv. then no new man is reauired, urovided 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: Patrick Sullivan <br />Permittee Name: Rio Grande County <br />Address: 168 N. Washington <br />Monte Vista, CO 81144 <br />Phone Number: (719) 852-4781 <br />Fax Number: (719) 852-0305 <br />If you have a ional comments and/or information that should be provided to the Division, please provide it <br />below r attach i to this form ong with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:\PERMIIIMASTERDOCUMENTS\A4-AF-04