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~~~ <br />RECEIl~E® <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />The Fort Lyon Canal Company <br />M-2001-097 <br />Fort Lyon -State Pit No. 1 <br />October 8, 2004 <br />SEP 10 2004 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Bent <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 />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished~to date and d;:ring 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 ymrr revised written anm~al rennrt and annual report m ~ to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Manuel Torrez <br />Permittee Name: The Fort Lyon Canal Company <br />Address: 750 S. Bent Ave. <br />Las Animas, CO 81054 <br />Phone Number: <br />Fax Number: <br />(719)456-0720 <br />(719)456-1609 <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 />\`\u 1o-v.s ~ 4~~NrEa d.4aT <br />Signature o Corpora fficer, Owner, or Designee <br />~~~~b <br />Date <br />