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RECEIVED <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Harold Brandstadt <br />M-1986-004 <br />Brandstadt Rock Pit <br />January 24, 2003 <br />JAN ~ g 2003 <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Delta <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 />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <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 ymir revised written anneal report and annul report mgp to thl.c form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Harold Brandstadt <br />Permittee Name: Harold Brandstadt <br />Address <br />Phone Number: <br />2040 G Rd. <br />Delta, CO 81416 <br />(970)874-4159 <br />-- -----Fax Number:- --- <br /> <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 />_~d a~ Gl -5 ,C~.~G <br />Signature of Corporate Officer, Owner, or Designee <br />~~~ ,~ /~ 02.0 ~ 3 <br />Dat <br />M:NERMITVNASTERnpCUMENTSVvI-AF-OI <br />