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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Q 1 <br />/1 1 <br />ANNUAL FEE and REPORT REQUEST <br />ent County <br />7M-2001-019 <br />Bent County Pit # 2 <br />June 22, 2010 <br />$$791.00 (Due on or before your anniversary date) <br />Bent <br />a!- <br />--a p <br />F-C1V0 <br />/MAY 1Y 2010 <br />Division of Reclamation, <br />40 Mining & Safety <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: Frank R. Bryant <br />Permittee Name <br />Address: <br />Bent County <br />P.O. Box 350 <br />Las Animas, CO 81054 <br />Phone Number: (719) 456-2223 <br />Fax Number: (719) 456-0375 <br />LcW(Z <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 />a- <br />Signature of Corporate Officer, Wrier, or Designee <br />r? S- 1 1-} O I n <br />Date <br />M:IPERMITVvIAS TERDOCUMENTS\M-AF-04