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~~~Gtwi~`C~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Park County <br />M-1977-365 <br />Sulphur Mtn Grav Pit <br />April 1, 2006 <br />$281.00 (Due on or before your anniversary date) <br />Park <br />Ii!{f~ ?_ ' 7.006 <br />Divielon of Idmerals antl Goolony <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 dis±urbances that are anticipated to <br />occur during the upcoming yeaz, 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 attac4,ynnr revised written annual report and annual renn# 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. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: ance <br />Permittee Name: Park County <br />-~rv~ rfv7z ~ a J ia, L..~,/ <br />Address: P.O. Box 147 <br />Fairplay, CO 80440 <br />Phone Number: (719) 8~5.4-282" cS~ 3 C-~ `~Z-8~ <br />Fax Number: (719) 836-4275 <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 />C ~ <br />Signa re o rporate Officer, Owner, or Designee <br />~-/ 7-O~ <br />Date <br />M:~PERMIT~MASTERW CUMENTSMS-AF-04 <br />