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6~k <br />w~ <br />RE~~w~~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Bent County <br />M-1983-178 <br />Bent County Pit <br />November 2, 2004 <br />$688.00 (Due on or before your anniversary date) <br />Bent <br />OCT 2 9 2004 <br />Division of Minerals & Geology <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,_rxclaination=accampiisiced°to~ate-and-dtrring-ihe~pre"ceding~year; new'disittrbances~that are anticipated Yo -- °--' <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 annnal re_pnrt and annnal report nil to Chic form- please note that an <br />adequately labeled map that clearly delineates and includes the aiiove 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: Gary Pritchard <br />Permittee Name: Bent County <br />Address: P.O. Box 350 <br />Las Animas, CO 81054 <br />Phone Number: (719) 456-2223 _ _ <br />Fax Number: (719) 456-0375 <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 an3 map. Annual Report instructions are <br />enclosed. <br />S' igna of Corporate Officer, Owner, or Designee <br />OC~eB~Q l y~ BOO <br />Dale <br />M:1PERh11nMA5TERDOCUMENTSU4-AF-04 <br />