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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Prowers County <br />M-1984-140 <br />Walker Pit North <br />August 31, 2003 <br />RECEIVED <br />AUG 1 4 2003 <br />Division of Minerals and GeolBsy <br />$281.00 (Due on or before your anniversary date) <br />Prowers <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 <br />-- --"oper~or shall "submit the anneal-fee,-a report-and map showing t1-ie extent of current disturbances to affected- -" - <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ymm revised written anmial rennrt and annual reo^rt man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mark Dorenkamp <br />Permittee Name: Prowers County <br />Address: 109 East Sherman <br />Phone Number: <br />Fax Number: <br />Lamar, CO 81052 <br />(719)336-5536 <br />(719)336-9633 <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 <br />enclosed. <br />t <br />Signature of7Corporate Offi ,Owner, or Designee <br />~/ <br />