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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Valco -Lamar Div <br />M-1977-223 <br />waey Plt <br />February 7,2005 <br />$688.00 (Due on or before your anniversary date) <br />Prowers <br />R~C~CIV~® <br />JAN 3 1 ~ <br />Division of Minerals and Geolo9Y <br />1"'c'-'' <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 />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 your revised written anmral red nrt and annual report main to this form. Please note thal an <br />adequately dabeied 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: Wayne Adams <br />Permittee Name: Valco -Lamar Div <br />Address: P.O. Box 591 <br />Lamar. CO 81052 <br />Phone Number: (719) 336-2223 <br />Fax Number: (719} 336-2224 <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 />~~~~ l/•4~~F.tilsc~ <br />Signature of Corporate Officer, Owner, or Designee <br />/- io - l05 <br />Date <br />