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ok <br />..? ?e- <br /> ANNUAL FEE'and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br /> <br />OPERATION NAME: kLas Animas County <br />XI-1983-039 <br /> <br />Airport Gravel Pit <br /> <br />??? <br />4AR 19 2009 <br />ANNIVERSARY DATE: April 28, 2009 Division of Reclamation, <br />Mining and Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Las Animas <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 chances to the previous vear's map are necessarv, then no new map 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: <br />Phil Dorenkamp <br />Permittee Name <br />Address: <br />Las Animas County <br />2000 N. Linden Ave. <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-2931 <br />Fax Number: (719) 846-0434 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />belquor attach it to this form along with your written report and map. Annual Report instructions are <br />of <br />, or Designee <br />(.3-1-4 -oa <br />Date <br />M: TERMI TWAS TERDOC UMENTSWI-AF-04