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44 j;,-, !"? <br /> ANNUAL FEE and REPORT REOUEST <br /> <br />PERMITTEE NAME: San Miguel County <br />PERMIT NO.: M-1989-030 <br />OPERATION NAME: Zadra Pit <br />ANNIVERSARY DATE: May 15, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: San Miguel <br />i <br />y- <br />???AY 2009 v <br />--According_to_.C.R.S. 3_4-32.5-1.1.6 or C.R.S. 34_3.2-116., -each year, on the -anniversary date- ff 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 durin the previous year and no <br />new chances 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 permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mike Horner <br />Permittee Name: San Miguel County <br />Address: P.O. Box 426 <br />Norwood, CO 81423 <br />Phone Number: (970) 327-4835 <br />Fax Number: (970) 327-4090 <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 />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:IPERMITIMASTERDOCUMENTS\M-AF-04