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I~ <br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Florence Sand & Gravel <br />M-1992-051 <br />Florence Sand & Gravel Pit <br />August 11, 2002 <br />JUL 1 6 2002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Fremont <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 yeaz, 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 yeaz, 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 report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Del Rodarmel <br />Permittee Name: Florence Sand & Gravel <br />Address: 799 5th St. <br />Penrose, CO 81240 <br />Phone Number: (719) 372-6025 <br />Fax Number: ~ ~/9)78'y 3 a-4/ <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 />t~.G ~~dL~E~t.2X ~6~CJrCal. <br />Signature of Corporate Officer or Owner <br />-~ /~ ~ ~ ~ <br />Date <br />M:~PERMITVNASTER000UM ENTSVN-AF-01 <br />