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<br /> ANNIIAi. FF.F. and RF.PnRT RFOi TF.ST <br />REe~ ~~ <br />PERMITTEE NAME: Prowers County <br />PERMIT NO.: M-1987-009 ~ ~ 2 ZQQ4 <br />OPERATION NAME: Jones Pit East Disision of Minerals $ Geol <br /> ogy <br />ANNIVERSARY DATE: February 26, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: 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 />°operator shall'submit-the-annuatfee; a-report-and map showing-the extent of current disturbances-to-aff eted - - <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 />Ptease attach ynnr revised written annual re~nrt and annnal re~prt 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 <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: 301 S. Main, Ste. 215 <br />Lamar, CO 81052 <br />Phone Number: <br />Fax Number: <br />(719) 336-5536 <br />(719) 336-2255 <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 />4 <br />Signature of Corporate OfFcer, Owner, or Designee <br />ate <br />M:V'ERMIT~MASTERDOCUMENTSNI-AF-04 <br />