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ANNU~EE anti REPORT REQUEST <br />FZEC~&V[~® <br />PERMITTEE NAME: City of Cripple Creek !~t?L 1 ~ 2007 <br />PERMIT NO.: ~ 1993-039 <br />plv on ofa d Safety n <br />OPERATION NAME: Midland Gravel Pit fining <br />ANNIVERSARY DATE: August 4, 2007 <br />ANNUAL FEE DUE: $323.00 (Due ou or before your anniversary date) <br />COUNTY: Teller <br />to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each..vear, on the anniversary date of the <br />operator snau suomn the annuat ree, a report ana map snowing the extent or current aismroances to auec[eo <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 resort 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 mad. If no new disturbances or reclamation have occurred during the previous year and no <br />new chanties 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 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: CF.PR.contact_first name <br />Permittee Name: <br />Address: <br />t'~ (-Iu~Frrinnl <br />City of Cripple Creek <br />337 E. Bennett Ave. <br />P.O. Box 430 <br />Cripple Creek, CO 80813 <br />CF.PR.contact_last_name <br />Phone Number: (719) 689-2502 ~ ~ 9 - 6 ~ 9 - ~ l ~ s <br />Fax Number: (719) 689-2774 ~ i 9- 6 N F- 012 ~ <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 />~~i~~ <br />Signature f Corpora e Officer, Owner, or Designee <br />O~~1~-07-07 <br />Date <br />M:~PERMI7~MASTERD000MENTSM-AF-04 <br />