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I <br />• III IIIIIIIII IIII III <br />999 I <br />ANNUAL REPORT ~ <br />~. RE~EIVED <br />PERMITTEE NAME: John Dillon ~ "' dUL !18 ~ <br />PERMIT NO.: M-1986-165 <br />OPERATION NAME: Willow Bend Division of A}nerdlSiGlObQy <br />ANNNERSARY DATE: August 27, 2000 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $281.00 <br />COUNTY: La Plata <br />According to C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the permi , an operator shall <br />submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances th tare anticipated <br />to occur during the upcoming yeaz, reclamation that will be performed during the co ing year, the <br />dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach our revised annual re ort ma and written re ort to this annual a ort. Please <br />note that an adequately labeled map that clearly delineates and includes the nbove el ments mny <br />suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone nu{rtber in the space <br />provided: <br />Contact Name: C~\l t C~ \ ~ I ~ ~ CYO <br />Ad~dres~s: ~ Cl `i`a ~I O <br />~_`~ la<'Gr Ca it Cf> <br />~~3~2 <br />Company:~Q~ Y~ C~ C~ (1~~ <br />Phone No.: l9'7(~ 1 ~y~~ 1 ~t3 <br />FAX No.: ~`aU <br />e-mail: r\ ~ <br />If there are additional comments and/or information that should be provided to the Di~ision, please <br />provide it on a sepazate sheet and attach it to this report form along with your map an or written <br />report. <br />~_ ~_~ r1 t ~ ~ ~ <br />Signature of Corporate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />M: PER A7 rI Vd ASTE R DOC U M EM SN1-A F-01 <br />