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999 • <br /> ANNUAL FEE and REPORT REQUEST RECEIVED <br /> PERMITfE:E NAME: Conejos County JUL 2 3 2001 <br /> PERMIT NO.: M-1987-097 Division of Minerals and Geology <br /> OPERATION NAME: La Florida Gray Pit <br /> ANNIVERSARY DATE: August 18,2001 <br /> ANNUAL FEE DUE: $281.00(Due on or before your anniversary date) <br /> COUNTY: Conejos <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 annual report and annual report map 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: Bob Lucero <br /> Permittee Name: Conejos County <br /> Address: 6683 County Rd. 13 <br /> P O Box 157 <br /> Conejos, CO 81129 <br /> Phone Number: (719) 376-5772 <br /> Fax Number: (719) 376-5661 <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 Corporate Officer or Owner <br /> _�?_Gi <br /> Date <br /> M?PERMfM1ASTERDOCUMENTSW AF-04 <br />