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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />?? "?- R?T <br />ANNUAL FEE and REPORT REOUEST <br />7chaffee County <br />/M-1978-192 <br />Pit No 6 <br />June 30, 2011 <br />RECEIVED <br />Division of Reclamation, <br />Mining & Safety <br />$323.00 (Due on or before your anniversary date) <br />Chaffee <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116; -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 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 may. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's may 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joe Nelson <br />Permittee Name: Chaffee County <br />Address: P.O. Box 699 <br />Phone Number <br />Fax Number: <br />Salida, CO 81201 <br />(719) 539-6961 <br />(719) 539-7442 <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 />of <br />or Designee <br />Date <br />M:IPERAIrAMASTERDOCUMENTS\M-AF-04