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<br />PERMITTEE NAME; <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Rio Blanco County <br />M-1977-136 <br />Prather Pit <br />February 23,2003 <br />RgCEiVED <br />MAY 15 2003 <br />~tYtston ~f Minerals and Geolog y <br />$688.00 (Due on or before your anniversary date) <br />Rio Blanco <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 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 your revised written annual report and ann 1~ r@ n~,R rt m~ 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 />YepOYt. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittea Contact: Rex-)-,~eger <br />Petmittee Name: Rio Blanco County <br />Address: 570 2nd St. <br />Meeker, CO 81641 <br />Phone Number: (970) 878-5601 <br />Fax Number: (970) 878-3396 <br />~¢ f f'tj ..JT~GG~G <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 />Signatur f Corpor e Officer, Owner, or Designee <br />Date <br />M:~PERMITMASTERDOCIIMENTSU1-Af-04 <br />