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<br /> r <br /> ANN AL FEE'.g REPORT REQUEST <br /> <br /> RECEIVED <br />PERMITTEE NAME: Washington County <br />PERMIT NO.: J/M-1983-001 vAPR 2 L L <br />OPERATION NAME: Cecil 11-34-49 Division of Reclamation, <br />Mi <br />i <br /> n <br />ng & Safety <br />ANNIVERSARY DATE: May 16, 2011 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Washington <br />_ According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116 each_near-, on the anniversary date of the permit, an _ <br />operator shall submit the annual fee, a report and map s owing N e extent o current istur ances to a ecte <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 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: Don Riemenschneider <br />Permittee Name: Washington County <br />Address: P.O. Box 32 <br />Anton, CO 80801 <br />Phone Number: (970) 383-2216 <br />Fax Number: (970) 383-2213 <br />If y have additional comments and/or information that should be provided to the Division, please provide it <br />bel w a h it to this form along with your written report and map. Annual Report instructions are <br />enc sed A //1 <br />SignAture of Corporate Officer, Owner, or Designee <br />bate <br />M:\PERMIT\MAS TERDOC UMENTS\M-AF-04 <br />