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.~ <br />' ~rs <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNTiAi, FF.F, and RF.PnRT RF.(ITTFST <br />°~,` <br />Dorgan County <br />//M-1978-162 <br />Harvey Green Pit <br />Juue 29, 2005 <br />~iE ~CEBi~~°: ~s;;l <br />~JJ~ JUL 0 52005 <br />'/" tlieision of Minerals and Gaalagq <br />$688.00 (Due on or before your anniversary date) <br />Morgan <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 carrent disturbances to affected <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 your revised written annnal rennrt and annnal re~nrt man to 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: Joe B. Baltazar <br />Permittee Name: ' Morgan County <br />Address: 17303 CR S <br />Ft Morgan, CO 80701 <br />Phone Number: (970) 542-3560 <br />Fax Number: (970) 542-3569 <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 />~-Ci <br />ignature of Corporate Offi •, Owner, or Designee <br />Date <br />M:~PERMIr4MASTERD000MENTSNr-AF-0q <br />