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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 REP~/O~RT REQUEST <br />Daniel M Russell <br />M-1995-034 ~/ <br />Bachus Pit <br />~C~1/ED <br />"~ JUL 0 8 2009 <br />July 10, 2009 ~~ ~~+~ of FdeC~am~tfon, <br />Mlnfig and Safety <br />$791.00 (Due on or before your anniversary date) <br />Alamosa <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />--- reclamation a~c~omp~tish~d to date and during the preceding year; new disturbances that are anticipated to-occur -- <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If uo new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required. provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Daniel M. Russell <br />Permittee Name: Daniel M Russell <br />Address: 9042 S. 106 Rd. <br />Phone Number: <br />Fax Number <br />Alamosa, CO 81101 <br />(719) 587-3630 <br />(719) 587-3632 <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 enclosed. <br />Signature of C orate Officer, Owner, or Designee <br />O ~v U <br />Date <br />