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~~ ~ v <br />ATVNiTAi. FFF and RFPiIRT RF(IiTF.CT RECEIVED <br />JUL 10 2004 <br />PERMITTEE NAME: D'Aun Mangus and LaTonne Mangus <br />Givision of Minarsls & Geology <br />PERMIT NO.: M-1978-221 <br />OPERATION NAME: K-Bar-T Pit <br />ANNNERSARY DATE: August 23, 2004 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />` reclamation-accomplished-ta-date-an$-~nt-ing-fhe-preceding yeas,-ne~v-disturbances3bataze_auticipated~ 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 anneal rennrt and anmral re nr m n to chic form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: D Aun Mangus <br />Permittee Name: D'Aun Mangus and LaTonne Mangus <br />Address: 4160 CR 8 <br /> Meeker, CO 81641 <br />Phone Number: (970) 824-2132 ~9 7t7~ g ~] $ - Jr.~c/ 7 <br />Fax Number: (970) 824-2132 ~ 9 70) ~8 - Sag 7 <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 />ignature of Corpo~ate ~cer, Owner, or Designee <br />to <br />