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;: <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Rio Grande County RECRiVED <br />PERMIT NO.: M-1978-066 OCT 16 2009 <br />OPERATION NAME: 10 Miles South Pit Division of Reclomiation, <br />ANNIVERSARY DATE: October 22, 2009 Mining and Safety <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Rio Grande <br />------According-to C.R.S-3.42.5-11.6_or-C.R.S.-3.4-32-116,-each year,_on_the_anniversa-y 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 man to this form The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated may. 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: Patrick Sullivan <br />Permittee Name: Rio Grande County <br />Address: 168 N. Washington <br />Monte Vista, CO 81144 <br />Phone Number: (719) 852-4781 <br />Fax Number: (719) 852-0305 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or atta it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />/7? <br />Si ature of Corporate Officer, Owner, or Designee <br />!7,:?3erQ? <br />Date <br />M:IPERMITIMAS TERDOCUNMNTS \M-AF-04