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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Date <br />M :\PERMITIMASTERDOCUMENTS\M -AF -04 <br />Permittee Contact: Bob Basher <br />Permittee Name: Delta County <br />Address: 501 Palmer St Ste 227 <br />Delta, CO 81416 <br />Phone Number: (970) 874 -5914 <br />Fax Number: (970) 874 -2455 <br />Signature of orporate Officer, Owner, or Designee <br />RP <br />ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br />Delta County / bC1 1 ¶ 2011 <br />M- 1978 -172 Division of Reclamation, <br />Mining & Safety <br />Antelope Hill Pit <br />October 26, 2011 <br />$791.00 (Due on or before your anniversary date) <br />Delta <br />According to C-.R-S. 34- 32- 5- 1- I6- or- C-.R -S- 34=32=11 each - year, on anniversary - date - of the perrriit, air -- - <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 />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 />