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d... , <br />CE,v ~~ <br />RE <br />QOZ <br />'UN Q 6 Z ANNUAL FEE and REPORT REQUEST <br />V <br />d f'ao\a9 <br />\ M;aata\S an <br />PERMIT"I'EE Yuma County <br />PERMIT NO.: M-1981-250 <br />OPERATION NAME: Brand Pit <br />ANNIVERSARY DATE: June 30, 2002 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Yuma <br />MAY~jO'2~?002 <br />~J <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an <br />-operator-shall-submit_the.annual fee,_a report,and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding yeaz, new disturbances that are anticipated to - <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />report. <br />Division records indicate [he following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Paul Like <br />Permittee Name: Yuma County <br />Address: 1310 S. Blake St. <br />Phone Number: <br />Fax Number: <br />Wray, CO 80758 <br />(970)332-5718 <br />(970)332-3429 <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 <br />enclosed. <br />~~~~ <br />Signature of Corporate Officer or Owner <br />~`~~-~ <br />Date <br />M:~PERM171MASTERD000MENTSVvI-AF-04 <br />