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N _ ~. - - <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 />f~J <br />.. <br />RECEIVED <br />OCT 2 t 2002 <br />4ivisiaarf Minerals and Ceolopy <br />Montezuma County <br />M-1999-077 <br />Ormiston Gravel Pit <br />October 25, 2002 ' <br />$688.00 (Due on or before your anniversary date) <br />Dolores <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an <br />_ _ .operator shall subm[_the_annual_fee, a.report_and map_show.ing.the extent of-current-disturbances-to affected- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during [he 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 report and annual resort maa to this form. Please note that an <br />adegaately 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: Lloyd Everett <br />Permittee Name: Montezuma County <br />Address: 1680 Hwy 145 <br />Cortez, CO 81321 <br />- -(970) 565-8666--- - - <br />Fax Number: (970) 565-8252 <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 instmc[ions are <br />enclosed. <br />~(gnatu're o~Corporate Officer, Owner, or Designee <br />/~o/ Z <br />Date <br />M:~PERMITNIASTRRDOCUMENTSUI-AF-05 --~ - _--'-~-- _ -' - - <br />-- -.e.,~.d.'1 ~~ <br />