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<br />• : t~ u a ~s i ~t~ \ s LSD ~4- <br />ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br />PERMITTEE NAME: Jefferson Count}' ~AN 2 5 2001 <br />PERMIT NO.: M-1977-245 <br />OPERATION NAME: Pine Junction Pit Division of Miner:.4: and Geology <br />ANNIVERSARY DATE: January 31, 2001 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Jefferson <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on [he anniversary date of the permit, an <br />operator shall submit [he annual fee, a report and-map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be perfonned during time 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 vour revised written annual report and annual report mau to [his form. P/ease mole that an <br />adequately labeled Wrap [hat clearly delrrreates nnrl incluc%s the above elements may saffrce for a wrruen <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Paul G. Rice <br />Pernmittee Name: Jefferson County <br />Address: 21401 Golden Gate Canyon Rd. <br />Golden, CO 80403-8108 <br />If you have additional conmments and/or infomma[ion tlma[ 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 />Phone Number: <br />Fax Number: <br />(303) 271-5205 <br />(303)271-5222 <br />~- <br />Signatu a of Corporate Officer or Owner <br />Jcr...w..,~ R3~ ~co! <br />Date <br />M ~PERMI"I\MASTERDOCIIM1ffNTSV•A-AF-OJ <br />