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i <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Rio Blanco County <br />M-1978-002 <br />Texas Creek Pit <br />February 23,2005 <br /> <br /> <br />Division of Yi~:.t%ic t r. ;nlnm~ <br />$281.00 (Due on or before your anniversary date) <br />Rio Blanco <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 annual fee, a report and map showing the extent of current disturbances to affected <br />-_-----land, reclamationaccomplished-to date and-during-the-preceding-year,_new disturbances_[hat-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 />Please attach your revised written anm~al rennet and annual report m n 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: -Ra~n~eeper <br />Permittee Name: Rio Blanco County <br />Address: 570 2nd St. <br />Phone Number: <br />Fax Number: <br />Meeker, CO 81641 <br />(970)878-5601 <br />(970)878-3396 <br />~~~~~; ~ F~ ~ o rl~n <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 /> <br />Signature of Corpor/~fe Officer, Owner, or Designee <br />/~ ~/D //~ <br />Date <br />M:IPERMITNrASlERDOCUMENTSUr-AF-04 <br />