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~h~ <br />~;~ /`~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Colorado Lien Company I~i^ <br />~-1977-ooz-HR <br />Munroe Gypsum Quarry <br />September 16, 2005 <br />~EP 0 9 c u5 <br />Division ai ilNio...r_:;, _ 3~olagy <br />$688.00 (Due on or before your anniversary date) <br />Lorimer <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />_ _._shall_submit -the _annual~ee,_a_report_and map- showing_the_extent_of-current disturbances to -affected-land- <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anm~al Yppnrt and anneal report main to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />PermitteeContact: LeciaCraft ShUty E~1CK$Ot~ <br />Permittee Name: Colorado Lien Company <br />Address: P.O. Box 767 P. U . C3 cx y 4 b <br /> Rapid City, SD 57709 <br />Phone Number: _(605).342_7224 __ <br />Fax Number: <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 enclosed. <br />Signature of orporate Officer, Owner, or Designee <br />9-(~-ate <br />H~ <br />Date <br />