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"~' <br />PERMI'PI'EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />I{iowa County <br />M-1990-148 <br />Gray Pit <br />February 5, 2004 <br />~~ <br />~9ti ~`~2 <br />P ~s FO <br />'a, <br />ad <br />$281.00 (Due on or before your anniversary date) <br />Kiowa ' S <br />According to C.R.S. 34-32.5-116 ar 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 estert-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 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 />Please attach ynnr revised written annual re~nrt and annual re~'f main to this form. Please note that an <br />adequately labeled map that clearly delineates and Includes the above elements may steffice 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: Rick Spady <br />Permittee Name: Kiowa County <br />Address: P. O. Box 100 <br />Phone Number: <br />Fax Number: <br />Eads, CO 81036 <br />(719)435-5810 <br />(719) 438-5327 <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 Repor[ instructions are <br />enclosed. <br />S ature Hof C porate O tcer, Owner, or Designee <br />/~ ~,~ -off <br />Dates <br />M:~PERMITMASTERDOCUMENTSUI-AF-09 <br />