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RECEIVEp <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Saguache County <br />M-1995-075 <br />Coleman Pit <br />April 25, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Saguache <br />MAR 3 1 1003 <br />Division of Minerals and Geology <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 <br />operator shall submit the annual fee, a report and map showing the extent of curzent disturbances to affected <br />-land, reclamation accomplished-to date and'durih'g`the pri:ceding year, 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 ymrr revised written anmral rennrt and annual rennrt mfn fn this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: John T. Ungefug <br />Permittee Name: Saguache County <br />Address: P.O. Box 476 <br /> Saguache, CO 81149 <br />-Phone Number: - (-7-19)655-2554- - -- -- -- - -- -°- ----- <br />Fax Number: (719) 655-2534 <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 />Si lure of Corporate O ce , r, or Designee <br />-~~,)~3 <br />Date ~y,n <br />HT /ru O /~M /IV I~T.PfI'f/tlN ~.~: '~,//9 Qe <br />Cl.1 Ec iC ~E y <br />MIPERMITMASTERDOCUMENTSN~I-AF-04 C.1 <br />