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/ RECEIVE® <br />JUL 1 1 2003 <br />Division of Minerals anA Geology <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lake County <br />M-1977-459 <br />Lake County iGrav Pit <br />July 8, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Lake <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 wilt 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 attachynnr revised written annual re~mrt and anm~al rennrt man to this form. Please note that an <br />adequately Tabeted 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 />_~ <br />Permittee Contact: ReHin-Sekiro ~~°J"v'y Rn ~~ <br />Permittee Name: Lake County <br />Address: P.O. Box 964 <br />Road & Bridge <br />Leadville, CO 80461 <br />Phone Number: (7]9)486-0259 <br />Fax Number: (719) 486-0259 <br />If you have additional comments andlor 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 />84(v - oo- 0~?7 <br />~OC~~~ ~~~~ ~ ~ <br />~~Y~}o~ <br />Signature of Corporate Officer, Owner, or Designee <br />G-z~ o~ <br />Date <br />M iPE2M ITVNASTERDOCUMENTSVN-AF-04 <br />