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Fax Number: <br />Date <br />© 7 7 <br />l <br />ANN AL FEE and REP RT REQUEST <br />RECEIVED <br />Kin 202011 <br />PERMITTEE NAME: f —L arry L Chartier Division of Reclamation, <br />/ Mining & Safety <br />PERMIT NO.: (�M -1984 -040 <br />OPERATION NAME: Chartier Pit <br />ANNIVERSARY DATE: July 19, 2011 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Morgan <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the eceding_Y_ear, ne_w distutbances_that are anticipatecLto occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Larry L. rtier <br />Permittee Name: Larry L Chartie <br />Address: 21305 Road 28.5 <br />Brush, CO 80723 <br />Phone Number: (970) 842 -5657 <br />Signature of Co orate Officer, Owner, or Designee <br />et° ciut, <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 enclosed. <br />