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C <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />Fremont County <br />M-1986-0X0 <br />Cottonwood Pit <br />January 20, 2011 <br />$$791.00 (Due on or before your anniversary date) <br />Fremont <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 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 man. If no new disturbances or reclamation have occurred during the previous year and no <br />new chances to the revious ear's ma are necessary then no new ma is re uired 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 C1ty, CO 81212 <br />Phone Number: (719) 2767300 <br />Fax Number; (719) 275-7304 <br />Paul Garrett <br />Canon City, CO 81212 <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 />enclgsed. <br />Si afore of Corporate Officer, Owner, or besee <br />i /'P <br />Date <br />M:\Przr0ZT MASTrRDOCUh4 NTSWAF-04 <br />9 /ti # LtNSLZ6LL? !WH9L:0L!LL-60-Z0