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RP A- Q(?T <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Ocity of Rifle <br />J M-2007-030 <br />City of Rifle Material Resource Area <br />June 13, 2011 <br />RIECEIV <br />/ JUN 13 2011 <br />Division of heclamation, <br />1 Mining and Safety <br />$323.00 (Due on or before your anniversary date) <br />Garfield <br />__According-to_C_R-S--34=32.5 -l1.6_or_C.R.S:-34-32_1.16,-each-yearon__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 map. If no new disturbances or reclamation have occurred during the previous year and no <br />new chances 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: Ra?lten^ <br />Permittee Name: City of Rifle <br />Address: 202 Railroad Avenue <br />Rifle, CO 81650 <br />Phone Number: <br />(970) 625-6223 <br />Fax Number: <br />(970) 625-6268 <br /> <br />q-1-1-0 - `Cs - 6!5-s*7 <br />If you have additional comments and/or information that should be provided to the Division,lease provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />F11-41-cg- <br />Signature of Corporate Officer, Owner, or Designee <br />6 <br />Date <br />M. \PERMITIMAS TERDOCUMENTS\1%4-AF-04