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/-W - kp f <br />AN AL FEE and REPORT REQUEST <br />PERMITTEE NAME: Alen Drilling and Excavating <br />PERMIT NO.: "``'''?? ?,?, 005-080 <br />OPERATION NAME: Allen Pit <br />ANNIVERSARY DATE: October 24, 2010 <br /> <br />SIP 2 2 2010 <br />Division of Reclamaon, <br />Mining & Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Park <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 preceding year, new disturbances that are anticipated to occur <br />dur--ing-the-upcommg-ye4r-, reclamation-that-will-be-performed during-the=eemi-ng-year, the-dates-for-the-beginning- - <br />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 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 may 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: Jack Allen <br />Permittee Name <br />Address <br />Phone Number: <br />Fax Number: <br />Allen Drilling and Excavating <br />P.O. Box 398 <br />651 Hwy 285 <br />Fairplay, CO 80440 <br />(719) 836-2672 <br />(719) 836-0715 <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 />Signa o Cor or e Officer, Owner, or Designee <br />September 21, 20 <br />Date