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~~/i1 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />McAtee Construction Co. <br />M-2004-070 <br />Bollish Pit <br />November 29, 2005 <br />$438.00 (Due on or before your anniversary date) <br />Logan <br />I, <br />According to C_R.S. 34-32.5-11_6 or C.R.S. 34-32-_116, each ear, on the anniversa date of the ermit, an o erator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected an , <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 rnnr revised written annnal red nrt and annual re,Pnrt main to this form- Please note [hat 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: William G. Lauer <br />Permittee Name: McAtee Construction Co. <br />Address: P.O. Box 1908 <br />Sterling, CO 80751 <br />- Ptrone-Number:-(970}~22~647 <br />Fax Number: (970) 522-9725 <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 />Gc.J~aLC~w.-. .-~ <br />~• ~, <br />Signature of Corporate Officer, Owner, or Designee <br />i ~ ag -os <br />Date <br />