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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />'("V '?- R4?-r <br />ANNUAL FEE and REPORT REQUEST <br />Y? Quarter Circle 8 LLLP <br />/ M-1980-003 <br />McNulty Cinder Pit <br /> <br /> <br /> <br />January 23, 2011 <br />$323.00 (Due on or before your anniversary date) <br />Eagle <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 />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 your 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 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: Sarah L. McNulty <br />Permittee Name: Quarter Circle 8 LLLP ?+? CAT fL?' C2EEK Ct N J 2S <br />Address: 7747 CR 100 7?47 CD y N ` ?'? )?o,4,) 10-0 <br />CA23o(--)-9) Co 81623 <br />Carbondale, CO 81623 <br />Phone Number: (970) 963-4363 <br />Fax Number: <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 />CA %, C(ZEWK Cla2)12R,? 4LC- <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />54hka . '01--e T. <br />W.?l? l??s . <br />;s ICU., <br />y?ry,?