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<br />e I kp T -. -r- r. ?;- <br />ANNUAL FEE and REPORT REQUEST <br />?pa-+ vU , <br />v ^?^ <br />PERMITTEE NAME: Kiowa County ' <br />PERMIT NO.: A-1991-074 <br />OPERATION NAME: Barnett Pit <br />ANNIVERSARY DATE: November 12, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Kiowa <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-eurrent 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. 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: Rodney Hopkins <br />Permittee Name: Kiowa County <br />Address: P.O. Box 100 <br />1305 Goff St <br />Eads, CO 81036 <br />Phone Number: (719) 438-5810 <br />Fax Number: (719) 438-5615 <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 />Sign ure of Corporate Officer, Owner, or Designee <br />Date <br />M:\PERMIT\ MIASTERDOCUMENTSW-AF-04