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©A, <br />?? -" W'OF <br />FEE and REPORT REQUEST <br />PERMITTEE NAME: ABent County <br />PERMIT NO.: PM-1991-086 <br />OPERATION NAME: Earl-Hoffman-Reyher <br />ANNIVERSARY DATE: October 3, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Bent <br />v /e <br />RECE"D <br />c--SEP 14 2009 <br />Dn"W of Fdeclam&tionf!% 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 <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 annuall 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: Frank R. Bryant <br />Permittee Name: Bent County <br />Address: P.O. Box 350 <br /> Las Animas, CO-81054-03-54--- = - - - `- <br />Phone Number: (719) 456-2223 <br />Fax Number: (719) 456-0375 <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, CAvner, or Designee <br />`>, zn cy? <br />Date <br />M:\PERMPIIMAS TERDOCT.7MENTS\N4-AF-04