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N~ ~~ <br />/„" <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Diana K. Watson <br />M-1981-275 <br />Stout -Amick Pit <br />March 5, 2004 <br />$688.00 (Due on or before your anniversary dot )ot Minerals and Geomr, <br />Rio Blanco <br /> <br />FEB 2 6 200 <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 operator <br />shall submit the. annual fee, a report and map showing the extent of current disturbances to affected land, <br />reelamation-aceemplished-fo-date-and-during-the-preeedmg-year;-netiv-dishrbanees-that-are-anticipated-to-aecur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annnal re~nnrt and annual re~prt m ~n to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Diana K. Watson <br />Permittee Name: Diana K. Watson <br />Address: P.O. Bos' 1056 <br />Meeker, CO 81641 <br />Phone Number: (970) 878-5898 <br />Fax Number: (970) 878-4523 <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 enclosed. <br />~~~~i~~ -o.~~ <br />Signature of Corporate Officer, Owner, or Designee <br />Date / <br />