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Il.~,+~ <br />e /~~) 1 <br /> ..- <br />.I <br />F1~ 6 <br />t kFl' <br />t ,. RECEIVED <br />1 F <br /> , <br />- <br />Okr I <br />~ <br />am <br />F O C <br /> <br /> • Mar > > Zoos <br />I'FR~II I•I'I{I' ~;\\i C. \lory;an ('aunty <br /> <br />' • GmeionotMinewbendGealop <br />PFR\Ifl <br />NO. ~I-1970-210 <br />O1'IiRAfION N:Ulli. \'aneil 1'it <br />r\NNI\'FRS:\Rl' 11;111'.: ~Iav 4• 11111, <br />ANNL .\I I•lil ht l S61{R.Oq (Doc nn nr before your unnivcrsrry dote) <br />C'Ol'N 11' \lur,:ut <br />\ca>rdutg to (•.R.S. 34.37..5-I lG ur C.R.S. 34-32-11G• rash year. nn the anmlCr5ar1' llatl' ui the pc:'nul, an <br />ulh.rdur shall suhnut the annual fee, a report and map shuwtng the extent of current disurrbunce to alfected <br />land, reclamation accomplished to date and dunng the preceding year, new drsutrbancrs drat arc anreq,atrd to <br />+xcur dunng the upcoming year, rcclamauun that well br prrti>nnrd during the coming year, the dates ti+r the <br />hc;arnm~ of active uperatiur.>. and ti:c dale acticr opcrruun..e;r+cd fi+r tF.c yr,u, tl am. <br />YI •ai ~r,_~+tr:+cFt your revised ,rrittrn annnnl rr~rt •+nd •+nno:+l report mn~[n this form P(~:uc nnfr dttt! uA <br />udrgauhdt' idh~•IrJ rrtup N:ut rlr,rr!•. ,Iriim•,ttrs octet utrluJr> tJrr ~rb,na rlrmrnlr rn,rr uej/trr Jr~r a rvritt~rt <br />report <br />Dtvuion records indicate tln: following pemntiec contact mformauun please verify and make any nreeswry <br />changes: <br />I'crmittce C.'untart: !,x B. R:dtaznr <br />prrmntre Name: Sturgan County . <br />Address: 17303 CR S <br />Fort Sturgan, CO SU701 <br />I'hunc Number. (970) 562-3560 <br />Fax Number: (970) 562-35(i9 <br />If you have additional eommrnu antL'or mlurmauon that should fx provuled to the Division, please provide n <br />below ur attach it to this form along with your written report and map. Annual Report instructions nrr <br />enc luscd. <br />/v ~L!~~!L!!!!r <br />• nature of ('„rporur Utticrr. - nee. or Designer <br />5 -/-6~ <br />dare <br />