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I !T <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Doren Stone <br />M-1997-089 <br />Stone Gravel Pit <br />July 8, 2002 <br />RECEIVED <br />JUL 1 5 2002 <br />Division of Minerals and Gaola®y <br />$688.00 (Due on or before your anniversary date) <br />Montezuma <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-fe , a e-extent'of-curter,:-disturbances-to-a€€eeted-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 yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for [he year, if any. <br />Please attach vour revised written annual resort and annual resort man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may saffice for a wrinen report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Daren R. Stone <br />Permittee Name: <br />Address: <br />Dazen Stone <br />~-Z4UVV lam„ <br />C?~ <br />Z ~ <br />Phone Number: <br />Fax Number: <br />(970)565-2603 <br />.~+-er-.,..., <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 aze enclosed. <br />Signature of Corpor fficer or Owner <br />~ -~ a~ <br />Date <br />M: W ERMRVdASTERDOCUMENTSV.I-AF-01 <br />