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_ ~7RvJ <br />. ~~,~,h~ <br /> ANNiiAi, FF.F. and REPORT R F.niJF.ST pp ~e <br />fl~lrt~..='.t 4i sab~ <br />PERMITTEE NAME: Wallace F. Burtis <br />PERMIT NO.: M-2001-070 AUG 0 9 2005 <br />OPERATION NAME: Florence Pit <br />Oivisi0n Oi Minerals and Geology <br />ANNIVERSARY DATE: August 23, 2005 <br />ANNUAL FEE DUE: $225.00 (Due on or before your anniversary date) <br />COUNTY: Teller <br />According to C.R.S. 34-32.5-] 16 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />S2perator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />......y .w .........................Y...,...,,..., ......, ..............b ...., p...ww,.b ~....., ..., .. ..,.,..........wo .,........, ..........r... w.. .,, <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 ynnr revised written annual rennrt and anm~al rePnrf main to 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: Wallace F. Burtis <br />Permittee Name: Wallace F. Burtis <br />Address: 66 Dartmouth Ave. <br />Pueblo, CO 81005 <br />~ _ Phone Number: (719) 566-1669 <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 <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />v'7-65 <br />Date <br />M:~PERMI7INASTERD000MENTS/M-AF-02.DOC <br />