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CEDE <br />peo r <br />ANNUAL FEE and PORT REQUEST MAR <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />k 't Carson County <br />M-1989-004 <br />Raymond Duell Pit <br />April 26, 2010 <br />$$323.00 (Due on or before your anniversary date) / ?, . <br />v"n .. of R lamIAaw, <br />Kit Carson - I Uining w.nd Safely <br />K1T CARSON COUNTY <br />MAR 3 0 2010 <br />According to _C.R.S. 34-32.5-1.16 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 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 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: Carol A. Fritz <br />Permittee Name: Kit Carson County <br />Address: P.O. Box 160 <br />Burlington, CO 80807 <br />Phone Number: (719) 346-8139 <br />Fax Number: (719) 346-7242 <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 />ure of Corporate Officer, Owner, or Designee <br /> <br />Date <br />M:TERMITgx4ASTERDOCUMENTS\M-AF-04