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Air *-R1Q_ <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Chaffee County I-le <br />M-1985-091 <br />Salida Pit <br />June 30, 2008 <br />Rs <br />3 2oas <br />Dibjsrarr ? L1___ <br />. ;??.r <br />Minis '°jyjatron, <br />9:.rad `vafegy <br />$$791.00 (Due on or before your anniversary date) <br />Chaffee <br />According, to C.R.S. 34-32.5-116 or C_ R S. 34-.32--116, each_yeaK on-the anniversary date o the_ n_etxnit?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 vour revised written annual report and annual report may 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 during the previous year and no <br />new changes 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 suff ce 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 />C -e <br />Chaffee County <br />P.O. Box 699 <br />Salida, CO 81201 <br />(719) 539-6961 <br />(719) 530-9208 <br />, n P_ 10r s _0a. Joe Nelson <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below oA attach it to this form along with your written report and map. Annual Report instructions are <br />enclose' d./ ../'i <br />of Corporate Offukr, Owner, <br />Date <br />M: \PERMITA4A S TERDOCUMENTS\A4-AF-04