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_ RECEIVED <br /> r <br /> III III�IIIIIIIIIIII OCT 1 1 2001 <br /> ANNUAL FEE and REPORT REOUEST Division of Minerals and Geology <br /> PERMITTEE NAME: Malouff Construction Inc. <br /> PERMIT NO.: M-1982-033 <br /> OPERATION NAME: Malouff Pit <br /> ANNIVERSARY DATE: October 8,2001 <br /> ANNUAL FEE DUE: $688.00(Due on or before your anniversary date) <br /> COUNTY: Conejos <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 accortiplishe—lc To-date and-durng ttre-preceuingyear, new-disturbances-thatare anticipated io 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 your revised written annual report and annual report map to this form. Please note that air <br /> adequately labeled inap that clearly delineates and includes the above elements inav 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: Stephen Malouff <br /> Perm ttee Name: Malouff Construction Inc. <br /> Address: 6496 Malouff Rd. <br /> Alamosa, CO 81 101 <br /> Phone Number: (719) 589-4198 33"1 <br /> Fax Number: (719) 589-2112 <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 /> �" V?&'L- <br /> —ldx4n Ney V/ /1' <br /> Sig ature of Corporate fficer or Owner <br /> /D - !d - o / <br /> Date <br /> M'\PERMITNMASTERDOCUME-FS\M�AF-01 <br />