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~C ~~ S <br /> ANNiiAT <br />FF <br />F <br />and REPORT RF <br />O iiF <br />ST <br /> , <br />. <br />. <br />. . <br />1/JUL 2 2 2005 <br /> ~ <br />~.~~ <br />PERMITTEE NAME: ,, <br />~ ' Mason A. King ~ p;~sion nt rm..... - . - <br />PERMIT NO.: /M-2004-036 <br />OPERATION NAME: King Pit <br />ANNNERSARY DATE: August 5, 2005 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Washington <br />~f <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-arg-anticipated_Yo_occut <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 ymir revised written anneal re~nrf and anm~al re~nrt m to this fnr~n. Please note [hat 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: Mason A. King <br />Pennittee Name: Mason A. King <br />Address: 6455 CR XX <br />P.O. Box 68 <br />Phone Number: <br />Fax Number: <br />Cope, CO 80812 <br />(970)357.4245 <br />(970)357-4349 <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 insfixctions are enclosed. <br />Signatu of Corporate Officer, O r, or Designee <br />7-zoos'' <br />Date <br />