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.4 <br /> <br />;% <br /> <br /> ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Washington CountY'? <br />PERMIT NO.: M-2004-021 <br />OPERATION NAME: Starlin Pit <br />ANNIVERSARY DATE: July 13, 2008 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Washington <br />RECEIVED <br />JUL 0 2 2008 <br />Division or Reclamation, <br />Mining and Safety P <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 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 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 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: r I <br />Permittee Contact: Tim ( Jaiu <br />Permittee Name: <br />Address <br />Washington County <br />150 Ash Avenue <br />Akron, CO 80720 <br />Phone Number: (970) 345-2337 <br />Fax Number: (970) 345-6593 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or ttach it to this form along with your written report and map. Annual Report instructions are <br />enclo d \ <br />SKnature of Corporate Offer, Owner, or Designee <br />y/) -- 6f <br />Date <br />M:\PERMITWASTERDOCUMENTS\N4-AF-04