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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />14F f\ 7- <br />ANNUAL FEE and REPORT RE UEST <br />City of Lamar <br />`'M-1987-078 <br />Lamar Park Grav Pit <br />June 24, 2011 <br />6oi&9 <br />-]"je 0 k' <br />RECEN <br />/JUN 16 2011 <br />Division of Reclamafion, <br />4 Mining and Safety <br />$$323.00 (Due on or before your anniversary date) <br />Prowers <br />According to C.R.S. 34-32.5-116 or C.R.S. 34732-116, 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 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: Patrick Mason <br />Permittee Name: City of Lamar <br />Address: 102 E Parmenter St <br />Lamar, CO 81052 <br />Phone Number: (719) 336-4495 <br />Fax Number: (719) 336-4404 <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 />e losed. <br />C <br />Signature of Corporate Officer, Owner, or Designee <br />/ -? 3/ a <br />Date <br />M: IPER Nfl7 WAS TERDOC UMENT S \M-AF-04