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z <br />z <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />r <br />A& FEEJand REPORT REQUEST <br />Kiowa County <br />?M-1983-112 <br />Murdock Gravel Pit <br />August 25, 2009 <br />$$323.00 (Due on or before your anniversary date) <br />Kiowa <br />RECEIVED <br />)JUL 16 2009 <br />Division of Reclamation, <br />Mining and Safet;t <br />-- - According to-C-:R-S: 344=3-2 5-1-1-6-or G.R.S-34-3-2 -1-1-6-each-yeai?--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 may 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. 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: Allen W. Watts <br />Permittee Name: <br />Address <br />Phone Number: <br />Fax Number: <br />Kiowa County <br />P.O. Box 100 <br />Eads, CO 81036 <br />(719) 438-5810 <br />(719) 438-5327 <br /> <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 />Signatur Corporate Officer, Owner, or Designee <br />Date <br />MAPERMITMASTERDOC UMENTS\M-AF-04