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IYd- <br />RECEI~/EI~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE; <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Georgia-Pacific Gypsum Corporation <br />M-1977-247 <br />Coatdale Quarry <br />Apri128, 2002 <br />APR 1 5 ,. v::? <br />DivisionaiR;in>*n:i ~^1:~.-'^"r <br />$688.00 (Due on or before your anniversary date) <br />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 operator <br />shall submit the annual fee, a report 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 tc occur <br />during the upcoming yeaz, 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 resort maa to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice far a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Kenneth S. Klco <br />Pemuttee Name: Georgia-Pacific Gypsum Corporation <br />Address: P.O. Box 338 <br />Cotopaxi, CO 81223 <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 i[ to this form along with your written report and map. Annual Report instructions are enclosed. <br />~..---~.~ ~k ,~ ~-P Gam,.-~. C°4~. <br />Signature of Corporate Officer or O er <br />~,p~ ~% t 2c~n'Z <br />Date <br />M:IPERMn WIASTERDOCUMENTSVN-AF-OI <br />