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<br />,fin <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Cecil C Powell <br />M-1995-012 <br />Powell's Gravel Pit <br />May 12, 2004 <br />$281.00 (Due on or before your anniversary date) <br />Moffat <br />~ ~ <br />RECEAVE® <br />~ar2~~ <br />Dirisinn of Minerals an4 BeoloBY <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 operator <br />shall` submitihe an`nual~ee-a~epart'and-map-showing--the-extent-of- current-disturbances_to_affected_land,____ <br />reclamation accomplished to date and during the preceding year, 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 for the year, if any. <br />Please attach your revised written anmral ren_nrt and anneal report m to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Perenittee Contact: Cecil C. Powell ~~ ~ ~ ~~Y -I I <br />Permittee Name: Cecil C Powell / (/° - ; L° <br />Address: P.O. Box 23 ~~ ~ ~3 <br />D~~~~saar, ~~ ~l CR l 0 <br />Dinosaur, CO 81610 <br />Phone Number: (970) 374-2329 ~~f /1'1 i~ i vt5 ~ fl-S ~~ ~D~ `e <br />- - ~r " jj d~ <br />Fax Number: `a ~ ~_q ~ ~0 , a ~T¢ I ~ <br />n,`yo r~to lamas o~~ hQ.~.le~;. <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 port instructions are enclosed. <br />St'J~r~ l ~eUrs /_a~a ~ f <br />i°,r l,. ~d-l,~ ~ ~ , ~ll~ ~ -t,ro +-,-i a., ,o,^~ a t0t,~ <br />Signature of Corporate Officer, Owner, or Designee <br />S D ~ ~' . -~ -~rovy-, ~ ~a-r <br />Date Smut E S <br />