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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />Kiowa County <br />M-1983-109 <br />A-drich Gravel Pit <br />August 25, 2003 <br />RECEIVED <br />AUG 0 1 2003 <br />Uirision ~f Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Kiowa <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 annuat fee, a report and "map sfiowing the eztenfof current 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 Xnnr revised written anmral rennrt and anneal tenor[ map to thin form- p(eaS¢ note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following perrnittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Rick Spady <br />Permittee Name: Kiowa County <br />Address: P.O. Box 100 <br /> Eads, CO 81036 <br />Phone Number: (719) 438-5810 <br />Fax Number: (719) 438-5327 <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 Retort instructions are <br />enclosed. <br />~~~ e%~J <br />tgnature of orp e Officer, Owner, or Designee <br />~ ~~~ <br />Date <br />M iPERM171MASTERD000MENTSUI-AF-04 <br />