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~,5 <br />ANNTTAT. FF.F, and RF.Pt7RT RF.Oi .ST V" <br />RECEIVED <br />PERMITTEENAME: Washington County <br />PERMIT NO.: M-1988-032 MAY 0 8 2004 <br />OPERATION NAME: Fassler Gravel Pit Dlvislon of Minerals & Deolo®y <br />ANNIVERSARY DATE: May 18, 2004 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <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 />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land,-reclamation_accomplishedxo-date_and_during the.-lxecedin~r,-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 re~nrt and anneal re,Pnrt main 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. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Tim Davis <br />Permittee Name: Washington County <br />Address: 150 Ash St. <br />Akron, CO 80720 <br />Phone Number: <br />Fax Number: <br />(970)345-2701 <br />(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 />Signature of Co orate Officer, Owner, or Designee <br />~r~,~ <br />DatTe <br />M:~PERMIi1MASTERDOC[IMENTSiM-AF-04 <br />