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u~/~~- <br />v' ANNi1Ai. FF.F, and RF.PnRT RF.(IiTF.ST <br /> <br />PERMITTEE NAME: <br />r/ Rio Grande County m~ ..- .. _.. , . ~ .~ <br />'n~~n^^ Y E <br />PERMIT NO.: !/ M-1987-020 ''aPR a a ~ <br />OPERATION NAME; 374 Pit ./ <br /> Oirisioo of iNioerala and Caologir <br />ANNNERSARY DATE: Apri123, 2006 <br />ANNUAL FEE DUE; $688.00 (Due on or before your anniversary date) <br />COUNTY: Rio Grande <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. ` <br />Please attach ymir revised written auroral red ort and annual report man to this form. please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lawrence "Buddy" Shaver <br />Permittee Name: Rio Grande County <br />Address: 168 N. Washington <br /> P.O. Box 46 <br /> Monte Vista, CO 81144 <br />Phone Number: (719) 852-4781 <br />Fax Number: J (719) 852-0305 <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 <br />enclosed. <br />~4~.c~rw-R. *~4~ri+t~+ <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:~PERMI7VMASTERD000MEMSUI-AF-04 <br />