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Q lam/ /\ <br />r <br />ANNUAL FEE and PORT REQUEST <br />RECEIVED <br />PERMITTEE NAME: Fremont County <br />PAN Q 4 2010 <br />PERMIT NO.: V41-1990-138 <br />OPERATION NAME: Stirrup Pit Division of Reclamation, <br />Mining $ Safety <br />ANNIVERSARY DATE: January 20, 2010 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <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- ubmit 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 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: Curtis Stone <br />Permittee Name: Fremont County <br />Address: Fremont County Commissioners <br />615 Macon Ave., Room #10 5 <br />Canon City, CO 81212 <br />Phone Number: (719)_2Z6-;3.2' <br />Fax Number: (719}3? <br />7lej a27? 7?a? <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 />Signature of Corporate bffficer, Owner, or Designee <br />Date <br />M:IPERMITkMAS TERDOCUMENTSW-AF-04