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©L13i~005 <br />Ll~ <br />PEItI~i1TTEE NAME: <br />PEIL'v11T NO.: <br />OPERATION NAME: <br />ANNIVE.7t.4A1ZY 1)AT'E: <br />Colorado City Metropoliwn Dia[ric[ <br />ivf-~ 9~9-lsa <br />Mountain Shadows Pit <br />December 20, 2004 <br />ANNUAL FEE DUE: $686.00 (Dua on or before your anniversary date) <br />COUNTY: Pueblo <br />J~d1J 2 G ~~'~~ <br />According W C.RS. 3492.5-116 or C.R.S. 34-32-116, oath year, on the anniversary date of the permit, an <br />operator shalt submit the attnuai flee, a report end tnnp showing the extent of current disturbances to affected <br />land, reclamation accotttplis:~ud to date and doting rho preceding year, new disturbances that are atuicipated to <br />occur during rho upcoming year, reclamation that will be perfomed durin@ the coming year, the dates for the <br />L•eginning of active operations, and the date active operations ceased for the year, if any. <br />Plnacn atach ytt+~•!i~~^ wriitan Ynn~~A! rs; nrt and annng]jg~nnrt mnn to this form- Please note lhQi or+ <br />adegrately labeled map that clearly delineates and includes the above elements may suffice for a wr,'trer+ <br />repan. <br />Division records indicaG; the following pe*ntittee eontaa information. Please verify and make :ny necessary <br />ohanges: <br />PermitteeCotttact: Ftanlcltiain <br />Pernuttee Name: Colorado City Metropolitan District <br />Address: 40.97 Hens Brothers Blvd <br />P. 0, Box 19390 <br />Colorado Ciry, C0 S 1019 <br />Phoue Number: (7l9) 676-3396 <br />Pex Nwnbor: (719) 676-3172 <br />1Cyou have additional comments ardor information that should be provided w the Division, please provide it <br />below or attach it to this fate along with your written report and tuap. Anrtttal Ropoxt instructions are <br />enclosed. <br /> <br />1!:NpaMI7N1.~5'rSan000MPNIJIM-AI'-0s <br />