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PERMITTEE NAME: Don Kehn Construction, Inc. RECE[,1/E® <br />PERMIT NO.: M-1989-056 FEB 1 Z 2003 <br />OPERATION NAME: Timnath Pit Oi~ision of Minerals atld GealoBY <br />ANNIVERSARY DATE: February 24, 2003 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <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 />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <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 ym~r revised written annual rennrt and annual rernrt mgp to this fnrm_ Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Kehn <br />Pemuttee Name: Don Kehn Construction, Inc. <br />Address: 6550 S. County Rd. 5 <br />. Phone Number: <br />Fax Number: <br />Ft Collins, CO 80528 <br />(970)226-4111 <br />(970)226-4115 <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 />~~ <br />Signature of Corporate Officer, Owner, or Designee <br />`~-O\-03 <br />Date <br />M1PEAMITMASTERD000MEMSVN-AF-01 <br />