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AN AL FEE'and REPORT REQUEST <br />PERMITTEE NAME: ALas Animas County RECEIVED <br />PERMIT NO.: P/M-2001-015 APR 3 0 2010 <br />OPERATION NAME: Sandoval Land and Cattle Pit Q? r+ of kmc?2ma4;on, <br />fiAfnfr? and Safety <br />ANNIVERSARY DATE: May 17, 2010 4er ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Las Animas <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 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 during the previous year and no <br />new changes 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 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: Phil Dorenkamp <br />Permittee Name: Las Animas County <br />Address: 2000 N. Linden Ave. <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-4766 <br />Fax Number: (719) 846-0434 <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 />enc ed. <br />r <br />ature of Corporate Officer, wner, or Designee <br />44-OD -1b <br />Date <br />M:\PERMITVMASTERDOCUMENTSW-AF-04