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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Mountain Region Corporation <br />M-1995-005 <br />Orchard Mesa Aggr <br />February 16,2003 <br />RE~~e~E~ <br />Jq~r ? ~ ?00,? <br />Division of Minerals and geabgY <br />$688.00 (Due on or before your anniversary date) <br />Mesa <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 />~I sl-ubmil-the ann- ual-fee; a`reptirt and map showing the extent of'cufrent distiubances-to affected-land;`Y- - <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 your revised written annual report and annual rennrt maw to this form- 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: Sandra R. DuCray <br />Permittee Name: Mountain Region Corporation <br />Address: 117 - 29 3/4 Rd. <br />Grand Junction, CO 81503 <br />Phone Number: (303) 242=5461 <br />_-(970)242=6728.--_" `-___ - _ _ __ - ; _ _ - _ - -- <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 />_~~,~ ~IJ~~ . P <br />Signature of Corporate Officer, ner, or Designee <br />i/~/~~ <br />Date <br />MIPERMITMASTERDOCUMENTSVA-AF-OI <br />