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jp?v 'y WT <br /> ANNUAL FEE and REPORT REOUEST <br /> `' <br />PERMITTEE NAME: Rio Blanco County <br /> <br />PERMIT NO.: M-1977-136 <br />OPERATION NAME: Prather Pit <br />ANNIVERSARY DATE: February 23, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <br /> <br />c°°)) <br />Erg: <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 vour 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 vear's map are necessarv. 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: David P. Morlan <br />Permittee Name: Rio Blanco County <br />Address: 570 2nd St. <br /> Meeker, CO 81641 <br />Phone Number: (970) 878-9590 <br />Fax Number: (970) 878-3396 <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 />gnature of Corpo ate fficer, Owner, or Designee <br />Date <br />M:\PERMIIIMASTERDOCUMENTS\M-AF-04