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<br /> <br />ANNUAL REPORT <br />PERMITTEE NAME: Prowers County <br />PERMIT NO.: M84136 <br />OPERATION NAME: Brann Pit <br />ANNNERSARY DATE: August 31, 1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: 225 <br />COUNTY: Prowers <br /> <br />RECEIVED <br />NOV O1 ~ggg <br />"~v,s~on of Minerals 8 <br />According to C.R.S. 34-32-1 16(3)(a), each yeaz, on the anniversary date of the perry <br />shall submit the annual fee, a report and map showing the extent of current disturbar <br />land, reclamation accomplished to date and during the preceding year, new disturbai <br />anticipated to occur during the upcoming year, reclamation that will be performed d <br />year, the dates for the beginning of active operations, and the date active operations <br />year, if any. <br />note that nn ndeyuntely labeled map that c[enrly delineates curd includes Jhe above <br />since for n written report. <br />Please type or print the current contact person's name, mailing address, and phone <br />provided: <br />Contact Name: ~Dk!>.(Q KDCkk Company: ~Y blJt;Y S <br />Address: IQq ~ ~e+'uBt 5{ PhoneNo.:(~1q) 336' <br />LR,MAti', CO B105z Fax <br />- 9633 <br />If there are additional comments and/or information that should be provided to the <br />provide it on a separate sheet and attach it to this report form along with your map <br />report. <br />~o-v, Cif~,~4 ,~~ ~o ' ~ g <br />Signature of Corporate Officer, or Owner Date <br />an operator <br />s to affected <br />s that are <br />ng the coming <br />ised for the <br />Please <br />may <br />in the space <br />~n, please <br />written <br />ItVSTRUCTIONS ON BACK <br />