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~~ <br /> <br />13ECEIVE® <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Bent County <br />M-1983-175 <br />Bent County Pit <br />November 2, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Bent <br />NOV 0 3 2003 <br />Division of fdinerels anA Geology <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-ihe-extent-of-current-disturbances-to~affected- -- <br />land, reclamation accomplished [o date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, 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 attach your revised written annual rennrt and annual rennrt maw to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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: Gary Pritchard <br />Permittee Name: Bent County <br />Address: P.O. Box 350 <br /> Las Animas, CO 81054 <br />-'- = 'Phone Numbei: - `~7f9)`456-2223"' ` - ~' - -'" -- f`- -' - ~-" - - - -"' - <br />Fax Number: (719)56=333- --~ (`y / 9l J-t s li - C~ 3 ~YS <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 />` Signatu of orporate O tcer, Owner, or Designee <br />~o -oc~ -3003 <br />Date <br />M:\PERMIT\MASTERDOCUM ENTSVN-AF-04 <br />