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ANNUAL FEE and PORT REQUEST <br /> <br />f RECEIVED <br />PERMITTEE NAME: <br /> <br />PERMIT NO.: Kit Carson County <br /> <br />/M-1982-067 <br />?AY 212009 <br />OPERATION NAME: Bledsoe Pit Div!Won of Reclamation, <br />tV Mining and Safety <br />ANNIVERSARY DATE: June 24, 2009 <br />ANNUAL FEE DUE: $$323.00 (Due on or before yo ur anniversary date) <br />COUNTY: Kit Carson <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 renort 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 Year's map are necessarv. then no new map is reouired, 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 />nature of o ate Officer, Owner, or Designee <br />- 0_C()R <br />Date <br />M: PERMIT\MASTERDOCUMENTSW-AF-04