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II \ <br />M~C~iVF~ <br />AR?42 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Benson Brothers <br />M-1977-062 <br />Hallenbeck Pit No 1 <br />Apri12, 2003 <br />nt~tse ~~3 <br />n of <br />MieeidtS ertd CeptegY <br />$688.00 (Due on or before your anniversary date) <br />Delta <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 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 />Please attach ymer r wised written annual tenor[ and annual refit mil, to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ed Benson <br />Permittee Name: Benson Brothers <br /> <br />Address: /~ <br />2134 J-50 Rd. ~ /~ <br /> Austin, CO 81410 <br />Phone Number: (970) 835-3128 <br />Fax Number: (970) 835-8567 <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 />Si nature of Corporate >icer, Owner, o Designee <br />,~~i a~/~~~~ <br />Date'~~ <br />M iP E R M I T VN AST E R DOC U M E NT SV.1-A F-01 <br />