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<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 />Walsenburg Sand & Gravel, Inc. <br />M-1978-283 <br />Sand Arroyo <br />Apri124, 2002 <br /> <br />RECEIVED <br />APR 15 202 <br />Division of 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 />reciamatioli acoomplishetl Yo date-anduarilTg'the preceding year,--new uisturbauces sitar ar~auticipated 70 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 your revised written annual report and annual report map to this form. 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: <br />Permittee Contact: Evelyn M. Vezzani <br />Permittee Name: Walsenburg Sand & Gravel, Inc. <br />Address: P.O. Drawer 352 <br />Walsenburg, CO 81089 <br />Phone Number: (719) 738-1883 <br />Fax Number: (719) 738-1883 <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 enclosed. <br />Si azure of Corporate Officer or er <br />- / U- O ~- <br />Date <br />M:~PERMITMASTERDOC UMENTSN4-AF-OI <br />