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r <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br /> <br />/? f <br />ANNU/A'L FEE-'and PORT REQUEST <br />/ ent County <br />VM-2004-057 <br />Reyher Trusts Pit <br />January 27, 2010 <br />$$791.00 (Due on or before your anniversary date) <br />Bent <br />'Ole- <br />?e <br />kECEIVED <br />//JAN 14 Z01Q <br />Division of jpmA9R; <br />Mining A §???iv <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 />_the extent of current disturbances to affected <br />operator--shall submit__the_annual_fee,_a-report and map showing <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: Frank Bryant <br />Permittee Name: Bent County <br />Address: P.O. Box 350 <br />725 Bent Ave <br />Las Animas, CO-81054-0350~ -- - - - - - <br />Phone Number: (719) 456-2223 <br />Fax Number: (719) 456-0375 <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 />Signature of Corporate Officer, Own , or Designee <br />1 Z-'7'009 <br />Date <br />M:IPERMITIMAS TERDOCIIMENTS\M-AF-04