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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANN FE]r a &dPORT REOUEST <br />4k <br />Morgan County <br />VM-1979-210 <br />Vancil Pit <br />May 4, 2009 <br /> <br />7 CEIVED <br />APR 3 0 2000 <br />Division of Reclamation, <br />Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Morgan <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-Teport-and-inap-showing the -extent -of-current-drsturbances 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 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 chances to the previous vear'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: XZWBX f <br />Permittee Name: Morgan County <br />Address: 17303 CR S <br />Fort Morgan, CO 80701 <br />Phone Number: (970) 562-3560 <br />Fax Number: (970) 562-3569 <br />John-Goodman <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 />enclosed. <br />S' ture of Corporate Officer, Owner, or Designee <br />Date <br />M: \PERMI T\MAS TERDOCUMENTS\M-AF-04