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v <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Elbert County <br />M-1988-101 <br />RECEIVED <br />DEC 0 3 2002 <br />Fondis Pit <br />December 15, 2002 <br />Division ~f Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Elbert <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. Please note tlxat an <br />adequately labeled map that clearly delineates mid includes the above elements may suffice 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: Marilyn Sproch <br />Permittee Name: Elbert County <br />Address: 809 Ute <br />Simla, CO 80835 ~x <br />Phone Number: (719) 541-2268 <br />Fax Number: (719) 541-2826 <br />If you have additional comments and/or information [hat 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 />Signature of rpora icer, Owner, or Designee <br />~-~. ~7 oz <br />Date <br />M iPERMR Vv1ASTERD000MEMSU4-AF-04 <br />