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6k-- <br />AN AL FEE and REPORT REQUEST <br />n o <br />f Limon <br />PERMITTEE NAME: Z.07. <br />PERMIT NO.: -198-103 <br />OPERATION NAME: Patty's Pit <br />ANNIVERSARY DATE: April 10, 2011 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Elbert <br /> <br />RECEIVED <br />APR 072011 <br />?Divillon of Reelamg0an, <br />Mining a Safety <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on_the amiversarv 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 reauired. 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 Stone <br />Permittee Name: Town of Limon <br />Address: P.O. Box 9 <br />Limon, CO 80828 <br />Phone Number: (719) 775-2346 <br />Fax Number: <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 Officer, Owner, or Designee <br />Date <br />M: TERMITUvfAS TERDOCUMENTSW-AF-04