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A4i?! i?- R?T <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />( <br />`Chaffee County <br />M-1985-091 <br />Salida Pit <br />June 30, 2011 <br />'ieC y?rr <br />Mi 1 9 cl ??fe atl?t?? <br />ty <br />$791.00 (Due on or before your anniversary date) <br />Chaffee <br />According to C.R.S. 34-32.5-116 or-C.R.S. 34-32-11-6, each year, on_theanniversary 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 may 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 durine the previous year and no <br />new changes to the previous year's may are necessary, then no new may 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: Rwx-J ws 3'e. Ne)SO" <br />Permittee Name: Chaffee County <br />Address: P.O. Box 699 <br />Salida, CO 81201 <br />Phone Number: (719) 539-6961 <br />Fax Number: (719) 530-9208 <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 />X ? 9, <br />Signa re of orporate Of icer, wner, or Designee <br />- //X l l <br />Date <br />M. TERMITIMAS TERDOCUMENTS\M-AF-04