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<br />~~QQ , ~`~-1 <br />ANNUA~~E~~~RT REQUEST l~ <br />PERMITTEE NAME: ~ Fremont County ~~~~! V ~® <br />PERMIT NO.: /M-1994-118 ~JUL 2 ~ Z007 <br />OPERATION NAME: Phantom Canyon Pit <br />~Bivision of~K d Safetyon, <br />ANNNERSARY DATE: August 8, 2007 Mining <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: 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`tlie annual-fee; a report and map s tl-owing tFie extent"of current disturbances to affected " f <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 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: Teny Action <br />Permittee Name: Fremont County <br />Address: County Commissioners <br />615 Macon Ave., Room #105 <br />Canon City, CO 81212 <br />Phone Number: (719) 276-7300 <br />Fax Number: (719) 276-7304 <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 />~~ " ~ <br />Signature of Corp rate Officer, er, or Designee <br />7~ d/v ~ <br />Dates <br />M:~PERMIriMASTERDOCUMENT5NI-AF-04 <br />