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Gt'l'l'~ <br />v ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ~/Kiowa County <br />PERMIT NO.: t/ M-1991-074 <br />OPERATION NAME: Barnett Pit <br />ANNNERSARY DATE: November 12, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: ICiowa <br />io ~ -~~ <br />~~i ~l ~ 7noF, <br />~/pivision otand Safety n, <br />Mining <br />- -- According_to-G.R.S. 34-32.5-1I6.or-C.R,S. 34-32=1.16, each. year, on_the anniversary date_of_the_pemut, 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 vour 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 durinc 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 inchtdes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: CF.PR.contact first name CF.PR.contact last name <br />Permittee Name: Kiowa County <br />Address: 1305 Goff St <br />P.O. Box 100 <br />Eads, CO 81036 <br />Phone Number: (719} 438-5810 <br />Fax Number: (719) 438-5329° <br />c?6~ <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 />en <br />u~ <br />Signature of Co orate O fip r, Owner, or Designee <br />Date <br />M:IPERMI7IMASTERDOCUM EMSVvl-AF-04 <br />