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' 4 7 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNA FEE and E TIREQUEST <br />Forest <br />'7M-2006-010 <br />MSF/Feister Pit #1 <br />August 9, 2009 <br />$$323.00 (Due on or before your anniversary date) <br />Las Animas <br />J <br />RIMMED <br />/AUG U 5 2009 <br />Division of Recla-martion, <br />44 Mining and Safety <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplis ed to -ate an u' ruing the pp-re`ceamg year,-n l'sturbances-that-are-anticipated-to-occur-------- <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the Drevious vear's map are necessarv. then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Scott Canda <br />Permittee Name <br />Address: <br />Phone Number: <br />Fax Number: <br />MS Forest <br />P.O. Box 521 <br />Aguilar, CO 81020 <br />(719) 941-4378 <br />(719) 941-4378 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />b or attach it to s form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of lCorporate Officer, Owner, or Designee <br />us <br />Date <br />