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C.° C S 1c- <br />0 14 r <br />ANNUAL FEE and REPORT REQUEST <br />Z D uglas & Patricia Sessions <br />2008-030 <br />fCeIVE® <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Sessions Pit <br />January 20, 2010 <br />$$791.00 (Due on or before your anniversary date) <br />Yuma <br />',/JAN 19 2010 <br />4-0 Division Mining of? and Safetyn <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation-accomplished-to_date_and during the pr__eceding_year, new disturbances that are anticipated to occur _ <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Douglas Sessions <br />Permittee Name: Douglas & Patricia Sessions <br />Address: 32416 Hwy 34 <br />PO Box 385 <br />Wray, CO 80758 <br />Phone Number: (970) 332-4657 <br />Fax Number: (970) 332-4617 <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 enclosed. <br />QSigatuarre of Corporate icer, Owner, or %ee <br />Date