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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Grasser Construction, Inc. <br />M-2001-052 <br />McCormick Pit <br />August 2, 2003 <br />AFcF~~Fo <br />Oiriaio <. 3 ~ 1pp3 <br />n rf M~nerdts egyCepie9y <br />$688.00 (Due on or before your anniversary date) <br />Kit Carson <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an operator <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to 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 Ynnr revised written annnal rennrt and annual rennrt mad to this 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: Daniel L. Grasser <br />Permittee Name: Grasser Construction, Inc. <br />Address: 18071 CR 31 <br />P.O. Box 192 <br />Stratton, CO 80836 <br />__Phone_Number: _(719)348-5383 __ _ <br />Fax Number: (719) 348-5931 <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 />!,t' ~ <br />Signature of Corp rate O icer, Owner, or Designee <br />~- <br />Date <br />M:NERM ITNIASTERDOCUMENTSVN-AF-01 <br />