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Permittee Contact: Joe C. Baxter <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />(719) 489 -3385 <br />(719) 489 -2265 <br />c. <br />ature of Corporate Officer, Owner, or Designee <br />0 / ) <br />Date <br />J AL FEE and REPORT REQUEST <br />PERMITTEE NAME: p. Kirkland Construction, RLLP <br />PERMIT NO.: '<VI- 1998 -038 <br />OPERATION NAME: Two Rivers <br />ANNIVERSARY DATE: August 3, 2011 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Pueblo <br />RECEIVED <br />i'AUG 01 2011 <br />/ z1,,, amation, <br />`7t7 :fety <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />- - during- the - upcoming- year —recla ion- that wil l -be- performed- during= the - coming -year he- dates-£or the beginning_ <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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 />Kirkland Construction, RLLP <br />P.O. Box 580 <br />2101 Main Street <br />Rye, CO 81069 <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 enclosed. <br />