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l4 <br />r <br />r / <br />AN(NAL FEE and PORT REQUEST <br />PERMITTEE NAME: Otero County (Engineering) <br />PERMIT NO: it X"M-1981-279 <br />OPERATION NAME: Hancock Gravel Pit <br />ANNIVERSARY DATE: February 1, 2011 <br />D,ys?r n W rr ;1 <br />i Aaron, <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Otero <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to <br />affected land, reclamation accomplished to date and during the preceding year, new disturbances that are <br />anticipated to occur during the upcoming year, reclamation that will be performed during the coming year, <br />the dates for the 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 man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, <br />and associated map. If no new disturbance or reclamation have occurred during the previous year <br />and no new changes to the previous vear's mat) are necessarv. then no new man is reauired. provided <br />that the Operator shall state this in the Annual Report. Please note that an adequately labeled map <br />that clearly delineates, and includes the above elements may suffice for a written report. <br />Division records indicate the following perm tee contact information. Please verify and make any <br />necessary changes: <br />Permittee Contact: Darryl L. Schulz <br />Permittee Name: Otero County (Engineering) <br />Address: P.O. Box 511 <br /> La Junta, CO 81050 <br />Phone Number: (719) 383-3035 <br />Fax Number (719) 383-3935 <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />it below or attach it to this form along with your written report and map. Annual Report instructions are <br />0 :?/ZZ' Signat <br />of Corporate office ner, Or Designee <br />Date <br />M: PERMIT/MASTERDOCUMENTS\M-AF-04