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<br />PERMITTEE NAME: Malouff Construction Inc. ~EC <br />EI~ <br /> <br />PERMIT NO.: <br />M-1982-033 , <br />E® <br />OPERATION NAME: Malouff Pit ~CT ~ 0 2003 <br />ANNIVERSARY DATE: October 8, 2003 Division of Minerals and Geology <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Conejos <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 />reclamation accomplished to date and during the 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 ymm revised written anneal rennrt and anneal report man to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Stephen Malouff <br />Permittee Name: Malouff Construction Inc. <br />Address: 6496 Malouff Rd. <br />Alamosa, CO 81101 <br />_- - __ .P.hone Number: (719) 589c4198 __ _ <br />Fax Number: (719) 589-2112 <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 />t'Sgnature of Corporate Officer, Owner, o Designee <br />Date <br />!~ -' k' - <br /> <br />.1 <br />MiPERMITMASTERDOCUMEMSVvI-AF-01 <br />