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/ S <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNA FEE and 41E?PPIOJRT/RIEOUEST <br />V <br />/Prowers County <br />1/ M-1984-140 <br />Walker Pit North <br />August 31, 2010 <br /> <br />D? <br />RV-CeIVED <br />/JSEP 0 2 2010 <br />Dlvieion of Rec?amaan• <br />Mining & Safety <br />V4 <br />$$323.00 (Due on or before your anniversary date) <br />Prowers <br />According to C.R.S. 34-32.5-116-fee,- orC.R.S. 34-32-116, each year, on the anniversary- date of the permit, an _ <br />operator shall submit the annual 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: Mark Dorenkamp <br />Permittee Name: <br />Address <br />Phone Number: <br />Fax Number <br />Prowers County <br />109 E. Sherman St. <br />-Lamar; CO 8-1052 <br />(719) 336-5536 <br />(719) 336-9633 <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 />i <br />Signature of Corporate O fiver, wner, or Designee <br />Date <br />M: \PERMIT\MAS TERDOCUMENTS\M-AF-04