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<br />~M <br />~,~,h~P 5 <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 />Sanborn Sand and Gravel <br />M-1984-094 <br />Gloria Z Mine <br />July 17, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Park <br />~~ ~- - - - - <br />JUL 1 8 2005 <br />Division cf R+;jnarxls £ ~:n(ng~ <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-t 16, 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-eurrent-disturbanees-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 fot the year, if any. <br />Please attach vour 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 acrd make any necessary <br />changes: <br />Permittee Contact. ~ a.~.~.e..°n-°v~mvr.r /t-f ~ G ~t 4 e / /'L ~ .~ Pri <br />Permittee Name: Sanborn Sand and Gravel <br />Address: " ~ ° F O, ~ o SIC / / & O <br />s! ~~?~fT o So ~/,2 c, <br />Fairplay, CO 80440 <br />Phone Number: t'(~'t'~eb' 9 JO ? $ Q ? (~ S ti <br />Fax Number: .{~1~a6-- _ r/ 9 ~ .i ~ o jg R-y- - - <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 instmctions aze enclosed. <br />Signa~~~` a Uficerorx <br />~ / /,~/e~`"~ <br />Dat~ <br />M:{PERMITiMASfERDOCUMENT54M-AFAI <br />