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<br />RECEIVED <br />/1AY 16201! <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />AZ v <br />ANNUAL FtE an REPORT REQUEST <br />VBent County <br />"M-2001-019 <br />Bent County Pit # 2 <br />June 22, 2011 <br />Division of Reclamation, <br />Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Bent <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: .494;Qgg- <br />Permittee Name: Bent County <br />Address: P.O. Box 350 <br />Las Animas, CO 81054 <br />Phone Number: (719) 456-2223 <br />Fax Number: (719) 456-0375 <br /> <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 />e 5"d. <br />&9?2'ia <br />Signature of Corporate Officer, Owner, or esignee <br />-II-2c? <br />Date <br />M: ?PERMITUYfAS TERDOCUIVtENTSM-AF-04 <br />DOW