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R <br />G <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COLJN'['Y: <br />~ ~~i <br />fNN"UAi. FF.F and RF.PtiRT <br />Z') to County <br />I-1978-168 <br />Pig Mesa Pit <br />October 26, 2005 <br />SS.~ <br />RJJECEI'V'EC <br />~OCT 2 42045 <br />ms~rn of Minerals oui 6eeiogq <br />~... <br />$688.00 (Due on or before your anniversary date) <br />Delta <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 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 your revised written annnal re~nrt and annnal re nrn t maP to this form. please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. mar/ ~~ ~~r~ r~~>~ <br />Division" records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Larry Record <br />Permittee Name: Delta County <br />Address: 501 Palmer St., Ste. 227 <br />Delta, CO 81416 <br />Phone Number: (970) 874-2100 <br />Fax Number: (970) 874-2114 <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 aze <br />enclosed. <br />t atu of Crorporate Officer,~wner, or Designee <br />2l Q~~o ~ ~ts>zS~ <br />Date <br />4 I <br />M:IPERMIT~MASTERDOCUMENTShf-AF.04 <br />