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ANNUAL FEE and REPORT REpUEST <br />Washington County <br />M-2000-084 <br />Chris Aaegeson Pit #2 <br />August 30, 2002 <br />AUG 0 8.2002 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />RECEIVED <br /> <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Washington <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 [he_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 annual report maa 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: <br />Permittee Contact: Chazles J. Kuntz <br />Permittee Name: Washington County <br />Address: 150 Ash <br />Akron, CO 80720 <br />Phone Number: (970) 246-3347 - - - - - - ~-- <br />Fax Number: (970) 345-2702 ~ if~~a /fii~z6/. ~ tiyt! <br />If you have additional comments and/or information that should be provided to [he Division, please provide i[ <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />( ~~ ysAJ ~,( I ~L.tJ~4.QSStA.., c/ <br />Signature of Co orate Offi~~ r or Owner <br />~'/- O ~ <br />Date <br />M:~PERMI'rN1 ASTERDOCU M ENTSN~I-AF-04 <br />