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10/28/2005 19:98 FA% <br />~l i <br />I <br />PBRMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNl`VERSARY DATE_ <br />ANNUAL FEE DUE: <br />COUNTY: <br />' Do glas County Sand & Gravel, LLC <br />983-089 <br />Douglas County Sand & Gravel <br />November S, 2005 <br />$685.00 (Duc on or before your anniversary date) <br />Douglas <br />~ 001/001 <br />RECE~1pED <br />~OCT 2 8 2005 <br />~Divisron of Minerals antl Geology <br />., _ _ Accordin¢ to C.R.S. 34-32.5-116 or C_R.S. 34-32-116, each mar, on the armiversary date of the ~errnit, an operator <br />shall submit the annual ^fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accompUshed to date and during the preceding yeaz, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annul ~epnrt and annual rPnnrt my~ to thi_c fnmr. please nnte that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jim Misken <br />Permittee Name: Douglas County Sand & Gravel, LLC <br />Address: 5360 Sunset Ih. <br />Littleton, CO 80133 <br />Phone Number: (303) 797-6013 <br />Fax Nutty~~r: ~ ~D - ~,`6 ~ "ZO ~~' <br />If you have additional comments and/or inf anon that should be provided to the Division, please provide it <br />~° 3 ~ ~~~ ~ ~~ ~or~ <br />below or attach it to this form along with your written report and map. Annual Report instructions ere enclosed. <br />Si lure of Corporate Officer, Owner, or Designee <br />Date ~l~_ ~'~ ®~ <br /> <br />$,ed„.,, °~_^-~^-~ ~? vim ' °v~v <br />6~ <br />