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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Georgia-Pacific Gypsum Corporation <br />M-1977-247 <br />Coaldale Quarry <br />Apri128, 2003 <br />RECEIVED <br />APR 181003 <br />Division N Minerals anA GeelogY <br />$688.00 (Due on or before your anniversary date) <br />Fremont <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 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 ~mlr revised written annual rennrt and annual rennrt m ~n to this fnrm_ 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: Kenneth S. Klco <br />Permittee Name: Georgia-Pacific Gypsum Corporation <br />Address: P.O. Box 338 <br />Cotopaxi, CO 81223 <br />Phone Number: (719) 942-4178 <br />Fax Number: (719) 942-4178 <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 />Signature of Corporate Officer, wne , or Desi ee <br />~~? l1~ ~I 7_.~~°1'~ <br />Date <br />M:\PERMITMASTERDOCUMENTSUA-AFA I <br />