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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Las Animas County <br />M-1997-100 <br />Branson Gravel Pit <br />January 16, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Las Animas <br />FiECE!VED <br />JAN 2 3 2003 <br />Division of Minerals and Geology <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on [he 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_accomplisbed_to=dare_and during the_preceding.year, new. disturbances that-are anticipated tom _ <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 />Pl ac afta h y n ~r rPVi.eed writt n anneal re}lnrt and annual report moo 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: Phil Dorenkamp <br />Permittee Name: Las Animas County <br />Address: 2000 N. Linden Ave. <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-2931 ~, _ _ _ _ ` `_, ` _ _ _ _ _ __I <br />Fax Number: (719) 846-0434 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attac~`(his form along with your written report and map. Annual Report instructions are <br />enclosed. / 1 <br />of <br /> <br />Date <br />or Designee <br />M:~PERMITU1ASTERb000MENTSVd-AF-04 <br />