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&,l o ) <br /> 999IIIIII III <br /> ANNUAL FEE and REPORT REQUEST RECEIVED <br /> I <br /> PERMITTF.E NAME: Fremont County <br /> JAN 2 2 2001 <br /> PERMIT NO.: M-1989-084 pirision o1 Ninarals and Geology <br /> OPERATION NAME: Oak Creek Gravel Pit <br /> ANNIVERSARY DATE: January 20,2001 <br /> ANNUAL FEE DUE: $281.00(Due on or before your anniversary date) <br /> COUNTY: Fremont <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 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 your revised written annual report and annual report man to this form. Please 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 permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Oscar Lee A'Zv,17P Tnc . kin k/co <br /> Permittee Name: Fremont County to t9. 6 o x 33Y <br /> Address: 615 Macon Ave., Rm. 102 <br /> Canon City, CO 81212 <br /> Phone Number: (719) 942-4178 <br /> Fax Number: (719) 942-4178 <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 /> S tjT <br /> Signature of Corporate Officer or weer <br /> -t <br /> � /O 1 <br /> Date <br /> M\PERMITMASTIZRDOCUMENTSVd-AF-04 <br />