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<br />~~o <br />PERMTiTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Orlando & Rose Marie Martinez <br />M-1985-008 <br />Leone-Gardner Gravel <br />March 22, 2004 <br />RECEIVEC <br />MAR 2 2 2004 <br />Division ~f Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Huerfano <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 preceding year, new disturbances that are anticipated to occur <br />- -during-the-upcoming-year;-reclamation-that-will-be-performed during-the-c-0ming-year,-the-dates for-the-beginning_ _ _ <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach~pnr reviced written annnal rennrt and annual re~. nn rt maTtn this fnrm_ Please note that an <br />adequately labeled map that clearly delineates and includes the 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: ;Y-- <br />Permittee Contact: -~^~^^a^ ~ re°~^ ~ <br />Permittee Name: o 'm~a.. ' u ^r "" ~-'' z <br />Address: I~Ciowa- <br />I~ebl~ea-sroo~- <br />Phone Number: f~19}54~3g33-- <br />Fax Number: <br />~at~tor~ ~i ~y ~[~ B 1 X15 <br />7i9-a75- /as3~ <br />'7r A - ~7L_ Q t2 A7 <br />~,-LKC <br />If you have additional comments and/or information that should be pro~he 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 />Owner, or Designee <br />~0 ~ ~ ~,wcess~ <br />