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<br />.~- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Bent County <br />M-2004-057 <br />Reyher Trusts Pit <br />January 27, 2006 <br />RECEIVED <br />DEC 1110Q5 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Bent <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 ahalC submtt ttie annual~ee, a report and map showing the extend current isms io aY2ected <br />land, reclamation accomplished to date and during the preceding 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 xnnr revised written anneal reFnrt and anneal rennrt m ~n 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: Gary L. Pritchard <br />Permittee Name: <br />Address: <br />Bent County <br />725 Bent Ave <br />P.O. Box 350 <br />Las Animas, CO 81054-0350 <br />Phone Number: (719) 456-2223 <br />Fax Number: (719) 456-0375 <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 />h/~ f 1.L~ <br />Signature of Corporate Of tcer, O er, or Designee <br />,lam -OCo -a-DY7L~, <br />Date <br />M:IPERMITNIASTERD000MEMSNI-AF-04 <br />