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<br />PERVIITTEE NAME: <br />PERMT[' NO.: <br />OPERATION NAME: <br />ANNIVERSARY llATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Leonard Loakonen <br />M-1986-085 <br />Weaver Quarry <br />December 5, 2003 <br />R~~C:~~"~G~~~ <br />MAR 1 (~ ~ppq <br />OirisionofMinera,_,.,_~ _ <br />$281.00 (Due on or before your anniversary date) <br />Latimer <br />!~ <br />~~ <br />According to C.R.S. 34-32.5-116 or C.R.S. 3432-116, each year, on the anniversary date of the permi[, an operator <br />shat! submit the annual fee, a reooR and trap showing the extent of current dis[utfiances to affected land <br />reclamation accomplished to date and during [he preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, [he dates for the beginning <br />of active operations, and the date active operations ceased fa the year, if any. <br />Please attach your revised written annual renort and annual report man m this form. Please note that an <br />adegtmtely labeled map that clearly delineates and includes the above elements may sa8ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: , <br />PermitteeCon[au: LconarrlLoukotten ~ yy1tCHAfL LOUkonJE~ <br />Perrnit[eeNatne: I:,eonardLOUkonen LOUKONt%tJ 8£O5. SION£ <br />Address: P-O. Box 333 ~ 2qq 3 N• ~mT N t LLS N W Y <br />Lyons, CO 80540 _ LOf.1Gth0 a TI CO . 80 SO 3 <br />Phone Number: (303) 823fi268 <br />Fax Number: -" - - - - - _" (3a 3) X23 - O 8 4 3 - -- <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 [his form along with your written report and trap. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or designee <br />318 ~a ~ <br /> ~ <br />~ <br /> <br /> <br /> <br />/y'~-t, , ~-cct <br />/z-S-o3, <br />Date <br />.~^-~` ~/ <br />u:teeas[m+usrrsnactnurxrss[-wrot ~,/ /,t7,'~ ^~ Gri'+~/T <br /> <br />J n ~ _ O~/ly- ~~~ <br />