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~..,• ~ ~ <br />sss `~ <br />ANNilAi. FF.F, and RF.Pi7RT RF.niTF.ST <br />PERMITTEE NAME: Delta County ~EriE~V~® <br />PERMIT NO.: M-1978-168 NOV 0 5 2004 <br />OPERATION NAME: Pig Mesa Pit <br /> Division ~f Minerals and Geolo <br /> <br />ANNNERSARY DATE: <br />October 26, 2004 gy <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Delta <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 />Pfease attach your revised written annnal report anal re~nrt main to this form- Please note that an <br />adequately labeled map that clearly delineatpes and includes the above elements may suffice for a written <br />report. ~[ S, .. ~-,~(r~J /~Ft/ <br />Division records indicate the following pemuttee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Larry Record <br />Permittee Name: Delta County <br />Address: 501 Palmer St., Ste. 227 <br />Delta, CO 81416 <br />Phone Number: (970) 874-2100 <br />Fax Number: (970) 874-2114 <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 />~~c.Z.4 (~ub(T j/ <br />i afore of Corporate Offic r, Owner, or Designee <br />.Z / X 4Je/176r r Z~.~ <br />Date <br />M:NERMITMASTERD000MENTSUI-AF-04 <br />