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~~ ~ ~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Grand County <br />M-1977-256 <br />Benson Pit <br />March 23, 2008 <br />~~ <br />~Ea ED <br />2 s Zoos (/~ <br />~,V.+u,e~~, ~t l - <br />'Niningand Sa eat~-, <br />$$791.00 (Due on or before your anniversary date) <br />Grand <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=steal su mI e annua ee; a report an map s~owmg the exten o current Istur ances to of of cted <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, reuort, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's man are necessary, then no new man is reauired, 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: <br />Permittee Name: <br />Address <br />Phone Number: <br />Fax Number: <br />Ken Haynes <br />Grand County <br />467 E. Topaz Ave. <br />P.O. Box 9 <br />Granby, CO 80446 <br />(970) 887-2123 <br />(970) 887-3168 <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 s form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Corporate Of Icer, Owner, or Designee <br />Z-?i(~~~ <br />Date <br />M: ~PERMIIIMASTERDOCUMENTS~M-AF-04 <br />~~ - - _ _ - <br />