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A? *- Wr <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 />ILo Grande County <br />,/ M-1987-019 <br />South Fork Pit <br />March 25, 2011 <br />$323.00 (Due on or before your anniversary date) <br />Rio Grande <br />RECEIVED <br />c/ MAR 10 2011 <br />Pcvi l <br />MiRng,&S <br />Ac-corcling?-tO-C.RS-14--325-U6_or-C.R'S,. 3_4.-32-1-1-6,-each year; on the-anniver-sar-r-date-ef-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 may 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 durine the previous year and no <br />new chances to the previous year's map are necessary, then no new may 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: Patrick Sullivan <br />Permittee Name: Rio Grande County <br />Address: 168 N. Washington <br />Monte Vista, CO 81144 <br />Phone Number: (719) 852-4781 <br />Fax Number: (719) 852-0305 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below' ac it to this fo along with your written report and map. Annual Report instructions are <br />en used. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:\PERAM'\MASTERDOCUMENTS\M-AF-04