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<br /> <br /> ANN A FE t and REPORT REOUEST <br /> V <br />PERMITTEE NAME: otero County <br />PERMIT NO.: LIr'I-2004-027 <br />OPERATION NAME: Mendenhall Pit <br />ANNIVERSARY DATE: August 20, 2010 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Otero <br />4/AU0 0 2 2010 <br />Dvttiori Ur R06 'n. <br />Oning and s j <br />4-0 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 />_ aerator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished t`o dated urmg t1-ie 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 chances 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: Darryl Schulz <br />Permittee Name: Otero County <br />Address: P.O. Box 511 <br />13 W. 3rd St. <br />La Junta, CO 81050 <br />Phone Number: (719) 383-3035 <br />Fax Number: (719) 383-3935 <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 />osed. <br />Signature Corporate Officer, Ow or Designee <br />Date <br />M: \PERMITIMAS TERDOCUMENTS\M-AF-04