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Refry ed OCT 2 X444 ANNT1Ai. FF,F, and REPn RT RF.niTFST/ D~V,SrDpo~~~nF1efdO~ ce R~ : ' PERMITTEE NAME N il' E ti \ ~®1 ~~ Pf ~ 3/s ~ G ~ : xcava e s ng ~ OCT ~ PERMITNO.: M-1980-143 ~9~~~ ptr~st OPERATION NAME: Texas Creek Grav Pit a n at ~~9araJ$ apd a ANNIVERSARY DATE: October 27, 2004 nalogy ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) COUNTY: La Plata 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 shall submit the annual fee, a report and map showing the- extent of current disturbances to affected land, reclamation accomplished-to date and during the preceding year, new disturbances that are anticipated to occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the date active operations ceased for the year, if any. Please attach your revised written anneal rennrt and anm~al rennrt man to this form- Please note that an adequately labeled map that clearly delineates and includes the above elements may since for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Bruce E. Neil Permittee Name: Neil's Excavating Address: 486 CR 515 Ignacio, CO 81137 Phone Number: (970) 884-i9A6 Z 2 90 _ Fax Number: (970) 884•?290 l ode U`a~~2.L.~j-O R r5~f ~ I v~ a If you have additional comments and/or information that should be provided to the Division, please provide it below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. Si afore of Corporate Officer, Owner, or Designee rD / 26~o y Date