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A ?- ?- Ro. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />4101 <br />Rio Blanco County <br />M-2004-038 <br />West Johnson Draw <br />cp-fVED <br />%/ JAN 0 8 2010 <br />Division of Reclamation, <br />Mining and Safety . <br />January 7, 2010 <br />$323.00 (Due on or before your anniversary date) <br />Rio Blanco <br />-According to.C.R.S. 34-32.5_-116 or_C.R.S. 3432-11.6, 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 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 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: Reft+eeper pa y i j P- m o c l an , 'R0 &c ft <br />Permittee Name: Rio Blanco County r.¢-c-+o <br />Address: 570 2nd St. <br />Meeker, CO 81641 <br />Phone Number: (970) 878-9590 <br />Fax Number: (970) 878-3396 <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 />ignature of Corporate ricer, Owner, or Designee <br />= bL-r 1 -1, aooq <br />Date <br />M:\pERNUT\MASTERDOCLTMENTS\M-AF-04 <br />t