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b~~~. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ ANNUAL FEE and REPORT REQUEST <br />t/ City of Cripple Creek <br />t/ M-1993-039 <br />Midland Gravel Pit <br />~ SEP 1 9 2006 <br />vision of Reclamation, <br />Mining and Sarety <br />August 4, 2006 <br />$281.00 (Due on or before your anniversary date) <br />Teller <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 <br />_ _ operator shall submit the annual fee, a report and map showierthe 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 man. If no new disturbances or reclamation have occurred durinc the previous year and no <br />new chances to the previous year's man 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 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: City of Cripple Creek <br />Address: 337 E. Bennett Ave. <br />P.O. Box 430 <br />Cripple Creek, CO 80813 <br />Phone Number: (719) 689-2502 <br />Fax Number: (719) 689-2774 <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 />~~, ~ ~~~- <br />Signature~/of Corporate fficer or Owner <br />-i~- Ofn <br />Date <br />