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r~ ~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />(/ ANNi1Ai. FF.F, and RF.PnRT RF.(1iTFST <br />v Grand Couuty <br />//M-1978-143 <br />Kremmling Airport <br />July 27, 2006 <br />RECEIi/ED <br />/JUN 2 1 2006 <br />$688.00 (Due on or before your anniversary date) <br />Grand <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be perforiried during the comir[g year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach xt~,nr revised written annual report and annual rennrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: CHANGE PERMITTEE CONTACT: <br />Permittee Contact: M C. Branstetter KEN HAYNES <br />Permittee Name: <br />Address: <br />Grand County <br />467 E. Topaz Ave. <br />P.O. Box 9 <br />Granby, CO 80446 <br />Phone Number: "(970)'887=2123 <br />Fax Number: (970) 887-3168 <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 <br />enclosed. <br />11.e.~ <br />Signature of Corpora fficer, Owner, or Designee <br />~~ /a ~ <br />Date <br />f/ <br />M:~PEAMlI VvIASTERDOCUM ENTS\'N-AF-04 <br />