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ANNU FEEn REPORT REQUEST <br />PERMITTEE NAME: --"'Fremont County <br />PERMIT NO.: ?PVI-1994-118 <br />OPERATION NAME: Phantom Canyon Pit <br />ANNIVERSARY DATE: August 8, 2008 <br />bWk <br />R Cif #vED <br />-QUA 2 2 2008 <br />Division of R <br />eci°Ination, <br />and Safety <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Teller <br /> <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-sha.l.l_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 man 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 vear's map are necessarv, then no new map 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: T-eien° <br />Permittee Name: Fremont County <br />Address: County Commissioners <br />615 Macon Ave., Room #105 <br />Canon City, CO' 81-212- - - - - <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 />Aj?? <br />Signature of Co orate Officer, Owner, or Designee <br />Date <br />M:\PERMIT\MASTERDOCUMENTS\M-AF-04