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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Ouray County <br />M-19'78-268 <br />Dallas Gravel Pit <br />March 22, 2003 <br />FiECEiVEp <br />FED t 11003 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Ouray <br />operator shall submit the annual fee, a report and map showing the 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 your revised written annual rennrt and anneal report map.tn this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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: Bob Wolford <br />Permittee Name: Ouray County <br />Address: P.O. Box 456 <br />Ridgeway, CO 81432 <br />Phone Number: <br />Fax Number: <br />(970)626-5391 <br />(970)626-4439 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it [o this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Corporate~ficer, Owner, or Designee <br />rte- /U'~~oo 3 <br />Dare <br />M:~P£RM ITMASTEADOCUM£NTSVv1.AF-04 <br />