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z .w <br />PERMITTRE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNTVEKSARY DATE,: <br />ANNUAL FEE DUE: <br />COUNTY: <br />9qq&-1 <br />AN A . FEE and e,4?U REQUEST <br />own County <br />M-1990-148 <br />Gray Pit <br />RECEIV90 <br />I/ <br />MAR 14 2011 <br />Ivtsion of Reclamation, <br />Mining and Safety <br />February 5, 2011 <br />$$323.00 (Due on or before your anniversary date) <br />Kiowa <br />According to C.K.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 ?nap 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 our revised written annual report and annual report ma 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 durin the revious ear and no <br />new changes to the previous ear's ma are necessary, then no new ma is required, Provided that the <br />Operator shall state this in the Annual Report. Please rote that an adequalely laheled map that clearly <br />delineates and includes the above elements nray vuffiee for a written report <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.O. Box 100 <br />Eads, CO 81036 <br />Phone Number: (719) 438-5810 <br />Fax Number: (719) 438-5327 <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 orpor Officer, Owner, or Designee <br />Date <br />MA1'VRM 7WAtiI'LRDOCl1M1jNT&M-AI?•04 <br />Jla J"eD <br />54958£ " 90M£8£0£ swan ?L:?L 80-£0-LLOE