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~ REG~'IVE® <br />JAN 2 3 2006 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNTiAT, FF.F. and RF,Pf)RT RF.T~iTF.ST ~~~ <br />Harold Brandstadt <br />M-1986-004 <br />Brandstadt Rock Pit <br />January 24, 2006 <br />$281.00 (Due on or before your anniversary date) <br />Delta <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 pemut, an operator_ _ _ <br />s a su mrt t e annua ee, a report and map s owing t e extent of current disturbances to affected land, <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 your revis d written annual report and annual report main to this form. Please note that 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: ~ f 1 // <br />Permittee Contact: Harold Brandstadt l°7 A. N'A ! Ci f`~~1~r~t ~~ c ( ~ f ~t r°l ~~ <br />Permittee Name: Harold Brandstadt ~Gf ~ A ~ ~ /~(~ Q)A C ~ .~ ~~~~ <br />Address: ~04964;~ ~~ ~~ ,~ ~ ~j-. ~~?'~ ~ <br />Delta, CO 81416 <br />- Phone-Number: <br />Fax Number: <br />(920)874-4159.- ----- ----- <br />~~~1't`~ ~ G~>, s'l~>~.~~ <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 />Signature of Corporate Officer, Owner, or Designee <br />Date <br />