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Ate - RPM <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Delta County RECE'ved <br />/ <br />PERMIT NO.: M-1978-168 ? 0Cr 12 2010 <br />OPERATION NAME: Pig Mesa Pit Division of Reclamation, <br />Mining & Safety <br />ANNIVERSARY DATE: October 26, 2010 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Delta <br />_ According to C.R.S. 34-32.5-116 or C.R.S_34-32-116,&ach 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 your revised written annual report and annual report may to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated may. If no new disturbances or reclamation have occurred during the previous year and no <br />new chances to the previous year's may are necessary, then no new may 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: Larry Record <br />Permittee Name: Delta County <br />Address: 501 Palmer St Ste 227 <br />Delta, CO 81416 <br />Phone Number: <br />(970) 874-2100 <br />Fax Number: <br />(970) 874-2114 <br /> <br />1FAO S7y-5-21V <br />97o-9Z51 -a;? <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 />ignature of orporate Officer, Owner, Designee <br />__Z'2192010 <br />Date <br />M: TERMITIMASTERDOCUMENTS\M-AF-04