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1 , , f <br />i <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/?-,' fir <br />ANNUAL FEE and REPORT REQUEST <br />-IYuma County <br />X2008-035 <br />Moser Pit <br />AUG 0 5 2009 <br />RECED <br />P//EP 01 2009 <br />Division of Heclamation, <br />40 Mining and Safety <br />September 24, 2009 <br />$$791.00 (Due on or before your anniversary date) <br />Yuma <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 accomplished 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 no 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 suffice for a written report. <br />-- -"' -Divfsiun records indicate-tli&-foHawing-permittee-contact`infc5rtiiation.-Please verify-and--make- any necessary <br />changes: <br />Permittee Contact: Mark Shaw <br />Llownlz'4 rnc?.rr1N? <br />Permittee Name: Yuma County <br />Address: 1310 Blake St <br />Phone Number: <br />Fax Number: <br />Wray, CO 80758 <br />(970) 422-3729 <br />(303) 423-7599 <br />70-- 33R- 5719 <br />q70-SS?- 3 47 <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 Corporate Officer, Owner, or Designee <br />ACS <br />Date