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,. <br />~ III IIIIIIIIIIIII III <br />999 V <br />ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br />PERMTTTfiE NAME: Fremont County <br />PERMIT NO.: M-1990-047 JAN 1 4 2002 <br />OPERATIC)N NAME: Qua{gmire Creek pjyjsion at Minerals and Gealopy <br />ANNIVER'iARY DATE: January 20, 2002 <br />ANNUAL ]'EE DUE: $251.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <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, 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 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 vour revised written annual resort and annual report map 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: -Ken-Klco <br />Permittee blame: Fremont County <br />Address: P:6'-BaR-338 <br />ut-CSAQP~1't . ~YST 3 5~ <br />~Afl4r`~R~~6rt~^ ~• <br />l F~rnionl C\~}~ CQ 'tb\Z~Z <br />(~etep~ a i 2 i 2 <br />Phone Number: (a-}9~-H42~ttT8 ~~-~"/~'~37~ <br />Fax Number: (.7.44}~4~N8' ~`OI - Z-'~ 5 • ~bZb <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 or Owner <br />1z/\~- of <br />Date <br />M.NERM rIV.1AtiTERD000AIENTSUI~AF~01 <br />