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PERMI-TTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Permittee Contact: Harold A. Winter <br />Permittee Name: Harold A Winter <br />Address: <br />Phone Number: <br />Fax Number: <br />20157 CR 75.0 <br />Trinidad, CO 81082 <br />(719) 846 -3570 <br />ANN AL FEE acid 1P:EPORT REQUEST <br />Harold A Winter <br />fff ��, /- 1985 -165 <br />/ Winter Ranch Pit <br />November 26, 2011 <br />$$323.00 (Due on or before your anniversary date) <br />Las Animas <br />COW <br />21 2011 <br />� 9 a & Sam oh, <br />p1v1 N 11n <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, reclamation that will be performed during the coming year, the dates for 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 />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 />c /jeS+icm f Please <br />Signa ure of Corporate Officer, Owner, or Designee + m Y sC)9 <br />r „ <br />Date <br />)),) / c) <br />r- ce <br />f�r r Cu r� -359-4 8a <br />1Q0 (< tick( <br />