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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />A tL FEE a d PORT REQUEST <br />Kit Carson County <br />-/M-1982-079 <br />Brenner Pit <br />June 24, 2009 <br />1J, <br />RECEIVED <br />AY 2 1 2009 <br />/ ®Ivi5ion of Reclamation, <br />?j Mining and Safety <br />$$323.00 (Due on or before your anniversary date) <br />Kit Carson <br />p4c <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 permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Carol Fritz <br />Permittee Name: Kit Carson County <br />Address: P.O. Box 160 <br />Burlington, CO 80807 <br />Phone Number: (719) 346-8139 <br />Fax Number: (719) 346-7242 <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 />ture of Co orate Officer, Owner, or Designee <br />15 - \? - ?oUQ <br />Date <br />M: TERMITIMAS TERDOCUMENTS\M-AF-04