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<br />RECEIVED <br />ANNiJAi. FRF, and RF.P(1RT RF.niiF.ST AUG 2 1 2003 <br />Division ~f Minerals and Geology <br />PERMITTEE NAME: Washington County <br />PERMIT NO.: M-1981-309 <br />OPERATION NAME: Y .Smith Pit #5 ~/, F. ~ x"' k~ ~J <br />ANNIVERSARY DATE: Au stZ7 2003~Z <br />ANNUAL FEE DUE: $PF.annual_fee (Due on or before your anniversary date) ~+t ~~ <br />COUNTY: 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 />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 ynnr revised written anneal report and annual rennrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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: Larry Champ <br />Permittee Name: Washington County <br />Address: P.O. Box 32 <br />Anton, CO 80801 <br />Phone Number: <br />(970) 383-3216 <br />Fax Number: (970) 345-2702 <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 o <br />Signature of Corpor e Officer, Ow r, or Designee <br />~~ /F ' 0 3 <br />Date <br />~-~~. 1,e~e ~re.- vt~ w'~-BPS 8-~ ~:~ <br />~, ~. ~..~ yo~,-o~vt~ sus <br />~. c.-~s. <br />(.cS c}n.s~_~ <br />M:IPERMITUTASTERDOCUMENTSNI-AF-04 <br />