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RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Allen P. Small Trucking & Excavation, Inc. <br />M-2000-103 <br />A.P.S. Trucking and Excavating, Inc. <br />January 23, 2003 <br />$281.00 (Due on or before your anniversary date) <br />La Plata <br />MAR 2 1 2003 <br />Division of Minerals and Geology <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 dis_tur_bances to affected land, <br />reclamation accomplished to date and during the preceding year, new drsturbances that are anticipate~to 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 yonr revised written annual renort and annual re~nrt to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffcce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pemtittee Contact: Allen P. Small <br />Permittee Name: Allen P. Small Tracking & Excavation, <br />Address: 13577 CR 213 - LA Posta Rd. <br />Durango, CO 81301 <br />Phone Number: (970) 259-2307 <br />- -- 'Fax'Number: - (970) 259-2307 - <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it [o this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />~_ of-~ <br />Date <br />nc. <br />M:IPERMI"nMASTERDOCUMENTSU-I-AF-01 <br />