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~jl~// ~. <br />~ ~Y~ <br />NNiiAT. FF.F, and RF.Pt7RT RF.OTiF,ST ~E~~~ Y ~® <br />PERMITTEE NAME: `M/ask, LLC "DIOV T 5 <br />PERMIT NO.: X41-2002-087 O~s~s,on of Minaols and GeoloeY <br />~... <br />OPERATION NAME: Mask Ranch Gravel Pit <br />ANNIVERSARY DATE: November 25, 2005 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Archuleta <br />r- <br />- Accor"~tng to .for - - , eac year, on t e anniversary ate o t e peimit, 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 coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Ptease attach your revised written annual tenor[ and annual rennrt m~tn 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: Dennis Walker <br />Permittee Name; <br />Address: <br />Mask, LLC <br />P.O. Box 5356 <br />Pagosa Springs, CO 81447 <br />Phone Number: (970) 264-5742 <br />Fax Number: <br />`1?D -~~~! ~'la~q <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 />~~~~ J~ ~. <br />Signature of Corporate Officer, Owner, or Designee <br />//~9/dam <br />Date <br />