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<br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />M Peter Schrepfer <br />M-]994-OOti <br />Emerald Vista Estate <br />March 11, 2002 <br />RECEIVED <br />FEB 2 ~ 2002 <br />Division of Minerals and Ceolag~ <br />$281.00 (Due on or before your anniversary date) <br />Las Animas <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 />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished (o date and during t1Se pi'ece~cing year; n`ew disturbances that are antic'ipatedTo`oc`cur <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 far the year, if any. <br />Please attach vour revised written annual report and annual report map to this form. Please note [ha[ 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: Frank Leone, Jr <br />Permittee Name: M Peter Schrepfer Q/( / ty Po f M/} j,'cW i S ~~/~'~'~ <br />Address: 502 S. Walnut <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-4170 <br />Fax Number: (719) 845-0605 <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 />.~,~-~ ; ~ <br />Signature of Corporate Officer or Owner <br />~ - /y- dZ- <br />Date <br />M:IPERMrRMASTERDOCUMENTSIM-AE-OI <br />