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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />Chaffee County <br />M-1985-091 ?/ / <br />Salida Pit <br />June 30, 2009 <br />RECEIVED <br />MAY 212009 <br />Division of Reclamation, <br />i/ Mining and Safety <br />$791.00 (Due on or before your anniversary date) <br />Chaffee <br />According-to-C.R.S._34-32.5-116 _or_C:RS,_ 3-4-32-1_L6,-_ each--year, on_the ann -ersaty-date_ _a£ VI"-- ermit. 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 durine the previous year and no <br />new chances 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: <br />Permittee Contact: the-i Mean Jun-e Jo?jes of ipe Nelson <br />Permittee Name: <br />Address: <br />Chaffee County <br />P.O. Box 699 <br />Salida, CO 81201 <br />Phone Number: (719) 539-6961 <br />Fax Number: (719) 530-9208 <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 />Kjg of Corporate Officer, Owner, or Designee <br />Date <br />M:\PERMITIMASTERDOCUMENTS\M-AF-04