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P, nyw-aA `lam +,,fl' <br />ANNUAL FEE and REPORT REQUEST <br />4/ <br />PERMITTEE NAME: ? Park County <br />PERMIT NO.: / M-1977-365 <br />OPERATION NAME: Sulphur Mtn Grav Pit MAR 18 2011 <br />on of Reclamation, <br />ANNIVERSARY DATE: April 1, 2011 40, Divi Mining and Safety <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Park <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 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: Dave' Kintz <br />Permittee Name: Park County <br />Address: P.O. Box 147 <br />Fairplay, CO 80440 <br />Phone Number: (719) 836-4283 <br />Fax Number: (719) 836-4275 <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 />Signature of Corporate cer, Owner, or Designee <br />:3 <br />Date <br />M:IPERMIT1MAS TERDOCUMENTS\M-AF-04 <br /> <br />_., 1r:. :.. .: ...>_. .. ,.... __ ??' - .x '?-s?..^.c., «n`??a.. ,....,?.,.:.1? _..?,. .:. s...,,.?.:: ?...?. .F,c..-.,.-, .s,.. +?:u:?i:33iJ•e?....:?:z? ,... _?