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t <br />,. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />iii iiiiiiiiiiiii iii <br />999 <br />ANNUAL FEE and REPORT REQUEST <br />Bear River Sand & Gravel <br />M-1986-040 <br />Bear River S & G <br />November 20, 2001 <br />RECceVE~ <br />NOV 2 1 2QC1 <br /> <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Routt <br />According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-I 16, each year, on [he anniversary date of the permit, an operator <br />_ _shall submit the annual fee, a report_and~map showing .[hex[eat-0f_current-disturbances-to-affected -land; <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated [o 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 your revised written annual resort and annual report mao to this form. Please note that an <br />adequately labeled map that ctem'ty delineates and includes the above elements rnm• since for n ~eritten report. <br />Division records indicate the following Permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: [aster Crawford <br />Permittee Name: Bear River Sand & Gravel <br />Address: P.O. Box 616 <br />Oak Creek, CO 80467 <br />Phone Number: (970) 736-2310 <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 />if <br />Si azure of Corporate Officer or Owner <br />1/ ~D - d <br />Date <br />M:WERA7ITUTASTERD000AIEMSN1~ AF-0l <br />