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;, ~~ IIIIIIIIIIIIIIIIIII ~ <br />ANNUAL REPORT <br />PERMITTEE NAME: Forest bakes Metro District ~~CE~VE~ <br />PERMIT NO.: M1981158 <br />OPERATION NAME: Forest 1Lakes Pit #1 ~ ~ g 2 8 2000 <br />ANNIVERSARY DATE: 1/26100 r;v~:.,:,~ at ~"'"etats8GC010gY <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 <br />COUNTY: La Plata <br />According to C.R.S. 34-32-116(3)(a), each yeaz, on the anniversazy date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances [o affected <br />land, reclatation accomplished to date and during the preceding year, new disturbances that are <br />anticipated to occur during the upcoming year, reclamation that will be performed during the coming <br />year, the dates for the beginning of active operations, and [he date active operations ceased for the <br />year, if any. <br />Please attach your revised annual report mao and written resort to this annual resort. P/ease <br />note that nn adequately lnbeled ,map thnt clearly de/rneates and includes the above elements may <br />since far n writtert report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: L.J/><.E KO~TZ Company: ~T ,/~~/'~Te=O QSTXLr <br />Address: 4 ~ t l7 ~~ Phone No.: (9~} ,~,lT- Z9L'~ <br />4 t o~ ~~ a'f/ZZ Fax No.:~~)oaT ~'D3~~ <br />If there are additional comments and/or information that should be provided to the Division, please <br />provide it on a sepazate sheet and attach it to this report form along with your map and/or written <br />report. n ~ SEE ~1~e7~ /t~wrvcle, ,Qt7~r2T <br />Msw76et~ <br />Z~ vU <br />Da[ <br />Signature of Corbo~te Officer, or Owner <br />INSTRUCTIONS ON BACK <br />