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<br /> <br />PERMITTEE NAME <br />PERMIT NO,: <br />OPERATION NAMr <br />r <br />AN eAL F. E and REPORT RFOOEST <br />?Kiowa County <br />-1991-078 <br />Peters Pit <br />)01?- <br />RECEIVW <br />4AR 14 2011 <br />1 9 Division of Reclamation, <br />Mining and Safety <br />ANNIVERSARY DATE: FZZ 4, 2011 <br />ANNUAL FEE DUE: (Due on or before your anuiversary date) <br />COUNTY: Crowley <br />According to C.R.S. 34-32.5-116 or C,R.S_ 14-32-116, 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 vour revised written annual report and annual report ma to this form. The Annual <br />Report &. Fee requirement is not nnet until we have received the following components: fee, report_and <br />associated map. If no new disturbances or reclamation have occurred during the revious ear and no <br />new changes to the previous vear's ima are necessary, then no new ma is required, Provided that the <br />Operator shall state this in the Annual( Report. Please nole that can adequately labeled map Owl clearly <br />delineates and includes the above elements may suffice )r a written reporl. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Rick Spady ?-? <br />Permittee Name: Kiowa County <br />Address: P.U. Box 100 <br />Eads, CO 81036 <br />Phone Number: (719) 438-5810 <br />Fax Number: (719) 438-5327( . YCJc? <br />If you have additional cotwnents 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, Q <br />/U <br />gnature of Co ora.l.e leer, Owner, or Designee <br />Date <br />X4-TEJW1'1'V'1W7 N? ? DGCUMENTSIM_AF-04 <br />9/9 d 54959£ « 9068Z£8£0£ S"a 5L:?L 90-£0-LLOE