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;' -'' <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Sand Creek Farms, Inc. <br />M-1992-038 <br />Sand Creek Mine <br />September 1, 2002 <br />RECEIVED <br />SEP 0 k 1002 <br />-~ <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Adams <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 c~lnit rhP ann„al~ee,_a_report and_tnap_showing.the_extent_of~urrent_disturhanc~tQ.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 [he beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour 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 report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permit[ee Contact: Wayne Pipkin <br />Permittee Name: Sand Creek Farms, Inc. <br />Address: P.O. Box 404 <br />Byers, CO 80103 <br />Phone Number: (303) 622-9491 <br />Fax Number: (303) 622-9551 <br />If you have additional comments and/or information that should be provided [o 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 />(N ` <br />Signature of Co rat Offi r, Owner, or Designee <br />1- ~ <br />Date <br />M iPERM,TMASTERD000MENTSU4-AF-01 <br />