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<br />•` • <br />III IIIIIItIIllII1Il ~,NNUAL ~POR~®.,r`~ <br />PERMITTEE NAME: Prowers County F~!'i <br />PERMIT NO.: M-84-136 AuG <br />OPERATION NAME: Srann Pit <br />ANNIVERSARY DATE: August 31, 1999 ,anot <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 <br />COUNTY: Prowers <br />According to C.R.S. 34-32-I 16(3)(a), each year, on the anniversary date of the pen <br />operator shall submit the annual fee, ~t report and map showing the extent of Curren <br />to affected land, reclamation accomplished to date and during the preceding yeaz, n <br />disturbances that are anticipated to occur during the upcoming yeaz, reclamation th <br />performed during the coming year, the dates for the beginning of active operations, <br />active operations ceased for the year, if any. <br />aanUal 1'epOrt. Please note that an adequately labeled map that clearly <br />includes the above elements may suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone <br />space provided: <br />Contact Name: DONALD KOEHN Company: PROWERS <br />Address: 109 E. SHERMAN ST. Phone No. : (719 ) <br />LAMAR, CO 81052 Fax No.: ( 719 ) <br />.C~E~ <br />g 199-9-~ ,,ma~yy <br />u, an <br />disturbances <br />will be <br />td the date <br />and <br />in the <br />If there are additional comments and/or information that should be provided to the L <br />please provide it on a separate sheet and attach it to this report form along with your <br />written report. <br />~t7hQ.~.f~ ~ AUGUST 18, 1999 <br />Signature of Corporate Officer, or Owner Date <br />and/or <br />INSTRUCT/ONS ON BACK <br />