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<br /> <br /> ff <br />" <br />/ <br />Y <br />? <br /> ANN <br />AFEE <br />an( <br />Jl <br />RtPO <br />RTREQUEST <br /> <br />? RLICLrIvLot) <br />PERMITTEE NAME: Prowers County <br />'-4ed <br />PERMIT NO.: 114-1987-009 es a f <br />OPERATION NAME: Jones Pit East Ovillpp of Reciftlon. <br />Mkft a saret, <br />ANNIVERSARY DATE: February 26, 2011 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Prowers <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 mapFshowing the-extent-or-cure nt 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: Mark Dorenkamp <br />Permittee Name: Prowers County <br />Address: 301 S. Main, Ste. 215 <br />Lamar, CO 81052 <br />Phone Number: (719) 336-5536 <br />Fax Number: (719) 336-2255 <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 Co orate Officer, Wim, a, ee <br />17- <br />Date <br />M: \PERMITIMAS TERDOCUMENTS\M-AF-04