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ANNUAL FEE and kEPORT REQUEST <br />PERMITTEE NAME: s Animas County <br />PERMIT NO.: " M -1997 -100 <br />OPERATION NAME: Branson Gravel Pit <br />ANNIVERSARY DATE: January 16, 2010 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Las Animas <br />7 D EC 212009 <br />Diviaien of Reclamation, <br />Mining and Safety <br />-- - - - - -- According to C.R.S. -34- 32.5 -.116 or-C.R.S.- 3-4=32-1.16, -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 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 <br />Permittee Name <br />Address <br />Phil Dorenkamp <br />Las Animas County <br />2000 N. Linden Ave. <br />Trinidad, CO 81082 <br />Phone Number: (719) 846 -2931 <br />Fax Number: (719) 846 -0434 <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 />c I * <br />a� X44 - (;e— <br />Y gnature of Corporate Offi r, Owner, or Designee <br />Date <br />M:\PERMITUvIASTERDOCUA4ENTS\N4-AF-04 <br />