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RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Pete Lien and Sons, Inc. <br />M-1977-304 <br />Rex Quarry -Sec 36 <br />September 26, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Larimer <br />SEP 2.12003 <br />Division ~f Minerals and Geology <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 dsturbances_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 ymrr revised written annual re~nrt and annual rennrt mgp to this 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: Lecia Crafr <br />Permittee Name: Pete Lien and Sons, Inc. <br />Address: P.O. Box 767 <br />Rapid City, SD 57709-0440 <br />Phone Number: (605) 939-2693 <br />Fax Number: <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 Corporat fficer, Owner, or Designee <br />~~/~ ~03 <br />Date <br />M:\PERMITU1ASTERD000MENTSVN-AF-01 <br />