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<br />PERMii'TEE NAME: <br />PERMiT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Glenn E. Sessions & Sons, Iac. <br />M-2003-058 <br />Fairbanks Pit <br />December 4, 2005 <br />$281.00 (Due on or before yonr anniversary date) <br />Jackson <br />lanwan vvo sleiau~yy to va~s~nip <br />5002 5 l ~3~ <br />a3ni~~3a <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 />---shali~-sabenit-tAe-annual -fee; s-report ar~map. showing-the-extentA~cwrent dishKhnn~ to .affected land- <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates far the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Pleaca attarh ym.r rnvicpd written nnnnn_I~gnnrt and annnal rnpnrf m~~ }n chic form. please note that an <br />adegnate/y labeled map that dearly delineates and includes the above elements may suJJlce for a written report. <br />Division records indicate the following petmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ronald F. Sessions <br />Permittee Name: Glenn E. Sessions & Sons, Inc. <br />Address: 33492 Hwy 125 <br />P.O. Box 1076 <br />Walden, CO 804g0 <br />Phone Number: (970) 723944 <br />Fax Number: (970) 723-8344 <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 />' ~ 5~~ <br />Si lure of Corporate O ficer, Owner, or Designee <br />is--a-o5 <br />Date <br /> <br />