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~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />t/ ANNUAL FEE and REPORT REQUEST <br />Prowers County <br />~M-2002-062 <br />Davis Pit <br />October 16, 2006 <br />RECEIVED <br />ocT ~ ~ 2nn5 <br />/ Division of RecSafeTY n' <br />Mining and <br />$688.00 (Due on or before your anniversary date) <br />Prowers <br />m~- <br />la~~- <br />_. Accordingao_C.R.S. 34-32.5-116 or C.R.S. 3.4_32-116 each year, on the anniversary date of the-permit_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 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 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 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 />Permittee Contact: Mark Dorenkamp <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Prowers County <br />109 E. Sherman <br />Lamar, CO 81052 <br />(719)336-5536 <br />(719)336-9633 <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~c~lo~sed. <br />/.~'/~ <br />Signature of Corporate Officer, caner, or Designee <br />p ti ~--0 <br />Date <br />M:IPERMITUQASTERDOCUMEN7'NN-AF-04 <br />