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Om K <br />PERMIT E NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~~~ ~i <br />ANNUAL FEE and REPORT REQUEST <br />Mike A Ferrero <br />,/1~I-2000-028 <br />Ferrero Pit <br />Apri126, 2008 <br />$$323.00 (Due on or before your anniversary date) <br />Huerfano <br />~~~~~~~~ <br />~ t1~Y 0 1 2008 <br />Division or Reclamation, <br />Mining and Safety <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />- --- - <br />during the upcoming year, rec amI afon`tfiat wi11`bz~ierformed=during the coining year,--the-dates for tfie_beginning_ __ __ <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinE the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Mike A. Ferrero <br />Permittee Name: Mike A Ferrero <br />'Address: 34320 Hwy. 12 <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-2176 <br />Fax Number: r ~y' fP- o1I/I (v ~ ~ ~ - ~~~(A'~ ~ ~o <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 />(../L <br />Signature of Corporate Officer, Owner, or Designee <br />~ 1 a Ins <br />Dat ~~ <br />