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.,1e- <br />r WCO <br />Ad�NIIAL FEE and REPORT RE VEST <br />° ✓EC o 7 2009 <br />Divi6ion c, and S � n, <br />PERMITTEE NAME: A city of Lamar Mining <br />LL-- <br />PERMIT NO.: t�M- 1984 -154 <br />OPERATION NAME: Well Field Pit <br />ANNIVERSARY DATE: December 10, 2009 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Prowers <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 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 map If no new disturbances or reclamation have occurred during the previous year and no <br />new chanzes 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 Mason <br />Permittee Name: City of Lamar <br />Address: 102 E Parmenter St <br />j Lamar, CO 81052 -3239 <br />Phone Number: (719) 336 -4495 <br />Fax Number: (719) 336 -4404 <br />1 <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 />7 7 <br />Signature of Corporate Officer, Owner, or Designee <br />IV <br />.2q <br />Date <br />M:IPERMITIMAS TERDOCUMENTS\M -AF -04 <br />