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A!P * A?--r <br />ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br />PERMITTEE NAME: San Miguel County <br />PERMIT NO.: M-1989-030 -?APR 13 2011 <br />OPERATION NAME: Zadra Pit Division of Reclamation, <br />Mining & Safety <br />'XV ANNIVERSARY DATE: May 15, 2011 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: San Miguel <br />According. to. C.R.S. _3.4-32.5=1-16-or C.R.S.- 34-32-416,-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 man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated may. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous vear's man are necessarv. then no new man is reouired. 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: Mike Horner <br />Permittee Name: San Miguel County <br />Address: P.O. Box 426 <br />Phone Number: <br />Fax Number: <br />Norwood, CO 81423 <br />(970) 327-4835 <br />(970) 327-4090 <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 />m? h"Az--? <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />//I f <br />MAPERM MMASTERDOCUMENTSW-AF-04