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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />ANNUA? F?E and PORT REQUEST <br />fpKiowa County <br />/I-1990-148 <br />Gray Pit <br />February 5, 2009 <br />RECTIVED <br />'t'IJAN 16 2009 <br />Division of Reclamation, <br />to Mining and Safety <br />$$323.00 (Due on or before your anniversary date) <br />Kiowa <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 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: Rick Spady <br />Permittee Name: Kiowa County <br />Address: P.O. Box 100 <br />Phone Number: <br />Fax Number <br />Eads, CO 81036 <br />(719) 438-5810 <br />(719) 438-5327 <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 />- 14 jk-?3 "enellz <br />Signa ure of Co orate ficer, Owner, or Designee <br />14el 9 <br />Date <br />M: \PERMITIMAS TERDOCUMENTS\M-AF-04