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ANNUAL FEE and PORT REQUEST <br />PERMITTEE NAME: ?P rk County ReCEWD <br />PERMIT NO.: -1980-014 . // <br />OPERATION NAME: Eleven Mile Pit MAR 16 2009 <br />ANNIVERSARY DATE: April 1, 2009 40 Division of Reclamatla0; <br />Mining and Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Park <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 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 changes to the previous vear's map are necessarv. then no new man is reauired. 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: Dave Kintz <br />Perm ittee Name: Park County <br />Address: P.O. Box 147 <br />Fairplay, CO 80440 <br />Phone Number: (719) 836-4283 <br />Fax Number: (719) 836-4275 <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 />en d. <br />Signature of Corporate O ficer, Owner, or Designee <br />Date <br />M: \PERMITUvfA S TERDOC IIMENTS\M-AF-04