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\11 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />? ?P <br />AN AL FEE and REPO 7 RE VEST <br />Las Animas County <br />,4-1998-011 <br />Unwin Gravel Pit <br />April 1, 2009 <br />D/C <br />, <br />jle <br />iAR 19 2000 <br />Division of Reclamation, <br />46 Miming and Safety <br />$$323.00 (Due on or before your anniversary date) <br />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 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. perm ittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact <br />Permittee Name <br />Address <br />Phil Dorenkamp <br />Las Animas County <br />2000 N. Linden Ave. <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-4766 <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 />below,or attach it to this form along with your written report and map. Annual Report instructions are <br />of Corporate Officer,J0,4her, or Designee <br />V .3-174-09 <br />Date <br />M:\PERMITMAS TERDOCUMENT S\M-AF-04