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ANNUAL FEE and REPORT REQUEST AOCT 15 2009 <br />PERMITTEE NAME: A71B nt Cou nty <br />C?ivision cr i-?clc.?71i1ti0n <br />PERMIT NO.: 1983-178 f? ^?nin9 and Safety <br />OPERATION NAME: Bent County Pit <br />ANNIVERSARY DATE: November 2, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Bent <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 -curTent- 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 vour revised written annual 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 vear's map are necessarv. 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 <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 />cz _ <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M: \PERMITIMA S TERDOC UMENTSW-AF-04