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O4^431.43/4~3. Sl <br />ICJ <br /> ANNIIAi. FF.F, and RF,PnRT RF ,ni1F.ST <br />RECEIVED <br />PERMITTEE NAME: Fremont County <br /> J~ 2 ~ 20 <br />PERMIT NO.: M-1986-010 4 <br />OPERATION NAME: Cottonwood Pit Dlvl~lon of Minerals $ goelcOY <br />ANNIVERSARY DATE: January 20, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <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 LtCe upcoming year, reclamation fltat will-be performed3uring iFie 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 v^nur revised written anneal rennrt and annual rennrt m}Ip to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Curtis Slone <br />Permittee Name: Fremont County <br />Address: Fremont County Commissioners <br /> 615 Macon Ave., Room # 105 <br /> Canon CIty, CO 81212 <br />Phone~iumber:-- (7_L9)_27b_7320 _. - __ _ _ - _-_ - <br />Fax Number: (719) 275-7626 <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 />e <br />_.__~ <br />S' nature of Corporate fficer, Owner, or Designee <br />/-/3- ° 5' <br />Date <br />M:\PERMITVNASTERDOCUMENTS\M-AF-04 <br />