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b At k- <br />7- <br />ANN&I fEE ana R O T REQUEST R D IVED <br />PERMITTEE NAME: Fremont County JAN 0 4 WO <br />PERMIT NO.: X1-1986-010 o91g100 of Rsawmdon, Set* <br />OPERATION NAME: Cottonwood Pit <br />ANNIVERSARY DATE: January 20, 2010 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <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 vour 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 changes to the previous vear's mat) are necessarv, then no new man 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:. 1-?a, L n-?-e -r--T- <br />Permittee Name: Fremont County <br />Address: Fremont County Commissioners <br />615 Macon Ave., Room # 105 <br />Canon CIty, CO 81212 <br />Phone Number: (719}3=?6-?3? t o? 7300 <br />Fax Number: (719)2-7?i 7( 7,23 oq <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 />1 -11111057 <br />Signature of Corporate fficer, Own-J, or Designee <br />Date <br />M: TERMIT\MASTERDOCUMENTS\M-AF-04