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~ iiiiiiiiiiiniiiiii ,~ <br />ANNUAL REPORT <br />PERMTTTEE NAME: Holyoke Gun Club <br />PERMIT NO.: M-77-075 <br />OPERATION NAME: Holyoke Gun Club Pit <br />ANNNERSARY DATE: September 27,1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 <br />COUNTY: Phillips <br />~ja„~,799 <br />'DECEIVED <br />., J, ,~ti <br />1.... , <br />of Minerab & Geology <br />According to C.R.S. 34-32-116(3)(a), each yeaz, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances <br />to affected land, reclamation accomplished to date and during the preceding yeaz, new <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this <br />annual report. Please note that an adequately labeled map that clearly delineates and <br />includes the above elements ntn su e for a written report. / <br />77iis Gravel -~;~`~95 i/1 ~ it~~%~° 5~~ ~~e ~as~" Nom= <br />Please type or print [he current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: GA,^ol er5 ~rldt Company: yJ~i/lJ~1P ~ uYt C~u~ <br />Address'~:!/ ,~/ S• ~i~~l, /rarv Phone No.: (97D) Lti?~ - ~~h~ <br />ftl ~i~/J,C~.o (t~/or~. Fax No.: ( ) <br />If there aze additional comments and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach it to this report form along with your map and/or <br />written report. <br />Signatur of Corporate~fficer, or Owner Date <br />INSTRUCTIONS ON BACK <br />