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~~ O~ N0~1 i 2 2C0~ <br />i^ioic.. a t..L.......5 ttuols04 <br />ANNTiAi. FF.F, and REPORT RF.ni1F,ST <br />PERMITTEE NAME: Richard E. Curry Marilyn L. Curry dba Tri-County Gravel <br />PERMIT NO.: M-1977-205 <br />OPERATION NAME: Tri-County Gravel <br />ANNIVERSARY DATE: November 29, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Delta <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 fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation-accomplishedyio irate and duribg`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 ym~r revised written anneal report and anm~al repnrf maw to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Richard or Thomas E. Curry <br />Permittee Name: Richard E. Curry Marilyn L. Curry dba Tri-County Gravel <br />Address: P.O. Box 566 <br />Hotchkiss, CO 81419 <br />Phone Number: (970) 872-3545 _ <br />Fax Number: (970) 872-3792 <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 />~~. ~ ~~~ <br />Signature of rporate Officer, O r, or Designee <br />1'1~-'-~ I o, C~ Y <br />Date <br />