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<br />• <br />III IIIIIIIIIIIIIIII <br />999 <br />ANNUAL REPORT <br />PERMITTEE NAME: Prowers County <br />PERMIT NO.: M-1984-136 <br />OPERATION NAME: Brann Pit <br />ANNNERSARY DATE: August 3"l, 2000 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $281.00 <br />COUNTY: Prowers <br />1 ~~ ~ <br />~3~. -- } <br />;FINED <br />2 42000 <br />and Geology <br />~~~~~ <br />(~ a, <br />Division of I <br />According to C.R.S. 34-32-1 l6(3)(a), each year, on the anniversary date of the perr <br />operator shall submit the annual fee, a report and map showing the extent of Curren <br />to affected land, reclamation accomplished to date and during the preceding year, n <br />disturbances that are anticipated to occur during the upcoming yeaz, reclamation th; <br />performed during the coming year, the dates for the beginning of active operations, <br />active operations ceased for the year, if any. <br />Please note that nn adequately labeled map that clearly delineates and includes <br />elements may since for a written report. <br />Please type or print the current contact person's name, mailing address, and phone <br />space provided: <br />Contact Name: DO',', a f c~ ~~~ k w <br />Address: / 0 4 ~. S ~7Y r ...vN a T. <br />/.Q ~v.QL ~Co- SCia51- <br />ut, an <br />disturbances <br />will be <br />id the date <br />nbove <br />in the <br />C as <br />~raw~ r~ <br />`t! <br />ompany: - vak <br /> <br />Phone No.: 7/ 9 ~3 - S' s 3 ¢ <br />FAX No.: 7~9 ~3 -96~~ <br /> <br />e-mail: <br />If there are additional comments and/or information that should be provided to the D <br />please provide it on a sepazate sheet artd attach it to this report form along with your <br />written report. <br />Signature of Corporate Officer, or Owner Date <br />INS1 RUCTIONS ON BACK <br />and/or <br />M:~PER M n V.1 ASTER DOCLIM ENTSNI-AF-Oi <br />