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<br /> r' ?r <br /> ?? te <br />ANN AL FE E and REPORT REQUEST MOM <br />PERMITTEE NAME: P//ark County <br />!/M-1997-035 /JUN 2 4 2009 <br />PERMIT NO.: <br />OPERATION NAME: Chaparral Pit 2 Df11W" of Re ?afion' <br />MiMng and Safety <br />ANNIVERSARY DATE: 5u?3iine-21, 2009 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Park <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. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: David Kintz <br />Permittee Name: Park County <br />Address: P.O. Box 147 <br />Phone Number: <br />Fax Number: <br />Fairplay.CO 80440 <br />(719) 836-4280 <br />(719) 836-4275 <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, O er, or Designee <br />Date <br />M :\PERMr[\MASTERDOCUMENTS\M-AF-04