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ANAL FEIJ angPORT REQUEST REGEIVEL) <br />PERMITTEE NAME: PMS Forest <br />OCT 0 6 2010 <br />PERMIT NO.: -2006-010 <br />OPERATION NAME: MSF/Feister Pit #1 <br />ANNIVERSARY DATE: August 9, 2010 / Division Minimof& Safety Reclamation, <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Las Animas <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_da.te-.and during-the-preceding-year,-new-distur-bancesAhat-`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 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 vear'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: Scott Canda <br />Permittee Name <br />MS Forest <br />Address: <br />Phone Number: <br />Fax Number: <br />P.O. Box 521 <br />Aguilar, CO 81020 <br />o.A4 04?jzn <br />f"Yl 3 -'T010'4 ,u.c _ <br />(719) 941-4378 1 Q _ C" 41 " 43-m <br />(719) 941-4376 D l q - 0 3?2 <br />If you have additional comments and/or information that should be <br />below ac it to t i -form alon I ur written report and map. <br />Signature o Corporate Officer, Owner, or Designee <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />q111 b 16 <br />Date