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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/ EE an RT RE UEST <br />ANN'IJ' F Q <br />Fremont County <br />?/ -2001-087 <br />Indian Springs Park Pit <br />February 11, 2011 <br />ptp''RECEN <br />°IAN 28 ?pt1 <br />Division of Reclamation, <br />Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Fremont <br />_year, on the anniversary date of the permit, an <br />--According-to. C.R:S. 34-32.5-116,or. C.R.S. 34-32-116, each <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 map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map 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: Paul Garrett <br />Permittee Name: Fremont County <br />Address: 615 Macon Ave., Rm. 105 <br />Canon City, CO 81212 <br />Phone Number: (719) 942-4232 <br />Fax Number: (719) 276-7321 <br />?1L?f ?.?,.?+?ne <br />1170 Red Canyon Road <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 />Date <br />M:IPERMITqvLAS TERDOCUMENTSUNI-AF-04