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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Harold A Winter <br />M-1985-165 <br />Winter Ranch Pit <br />November 26, 2002 <br />~~ <br />o~c~~~F~ <br />v <br />~~v/stop o f~/° of 2QO~ <br />a°dCeplOBY <br />$281.00 (Due on or before your anniversary date) <br />Las Animas <br />According [o 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 suhmit_Ihe_annual_fee,_a_report_and_rllapshawan~thP P*~P~~ of ~ii^P^r ri;cr„rt,a„rac rn aefarrarl lani7 <br />reclamation accomplished [o date and during [he 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 annual report and annual report map 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 />Permittee Contact: Harold A. Winter <br />Permittee Name: Harold A Winter <br />Address: 20157 CR 75.0 <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-3570 _ _ I ~~ ~~ <br />- - ',t , <br />Fax Number: <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 enclosed. <br /> <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M iPERM n1MASTERDOCUMENTSN~I-AF-01 <br />